Search Results (3,001)

In 2011, the International Commission on Radiological Protection (ICRP) recommended reducing the annual equivalent dose limit to the eye lens. This study investigated the effects of physician height and years of experience on lens radiation exposure in a clinical setting. The lens dose was measured using the DOSIRIS dosimeter, which quantified Hp(3) while accounting for the shielding effect of lead glasses, and a neck dosimeter for Hp(0.07). A significant negative correlation was found between physician height and both Hp(0.07) (R = −0.642) and Hp(3) (R = −0.728), suggesting that taller physicians received lower lens doses because of their greater distance from the scatter source. A positive correlation was observed between years of experience and Hp(0.07) (R = 0.650). Two-group comparisons showed that physicians shorter than 170 cm had a 2.77-fold higher median Hp(3) than those ≥170 cm (p < 0.05). As experienced physicians may be exposed to higher radiation levels, regular review of protective practices and continued radiation safety education are essential, regardless of clinical experience. This is the first clinical study to simultaneously evaluate the effects of physician height and experience on lens dose in interventional cardiology. Regular review of protective practices remains essential regardless of operator height or experience. Full article

The vascular anatomy of the stomach is both complex and highly variable, with direct implications for oncologic, bariatric, esophageal, and interventional procedures. This comprehensive review combines anatomical, radiological, and surgical evidence on arterial and venous variations in the stomach. The left gastric artery, traditionally the first branch of the coeliac trunk, often shows variants such as a direct aortic origin or association with an abnormal left hepatic artery. The right gastric artery most frequently arises from the proper hepatic artery, but its origin can vary significantly. The gastroepiploic arteries exhibit diversity in their origin, size, and connection patterns, with occasional duplication or absence. Additional vessels, including the posterior gastric artery and the short gastric arteries, also contribute to variations in arterial supply. Venous drainage largely follows the arterial pattern. The left and right gastric veins and the gastroepiploic venous arcade are major routes, while variants of the left gastric vein and the gastrocolic trunk (Henle’s trunk) contribute to complexity through different convergence patterns. These vascular variations have significant clinical implications, as they impact the safety of D2 lymphadenectomy, the risk of ischemic complications during laparoscopic sleeve gastrectomy, the success of gastric conduit formation in esophagectomy, and the effectiveness of transarterial embolization for upper gastrointestinal bleeding. Preoperative vascular mapping with multidetector computed tomography angiography and 3D reconstruction reliably defines individual anatomy, allowing for customized surgical planning and reducing operative risks. Recognizing both common and rare gastric vascular variants is essential for safe and effective surgical and endovascular management of gastric disease. Full article

Background: Several sarcoidosis patients require treatment with corticosteroids to prevent organ damage and control symptoms. However, corticosteroids are associated with numerous side effects and can be detrimental to patients if used long-term. Roflumilast is approved for the treatment of chronic obstructive pulmonary disease (COPD) and has been studied with positive results in patients with fibrosing sarcoidosis. Due to its mode of action, it targets proinflammatory and profibrotic pathways involved in sarcoidosis and could be a suitable medication for sarcoidosis. Methods: We retrospectively analyzed a cohort of 51 sarcoidosis patients treated with Roflumilast off-label between 2010 and 2020 at the Department of Pneumology, University Hospital Freiburg. Medical records, lung function, and laboratory results were reviewed. Results: Of the 51 patients, 33 patients received Roflumilast for at least 6 months, whereas 18 discontinued treatment, mostly due to mild to moderate gastrointestinal side effects (n = 7). No severe adverse events were observed. Patients on Roflumilast were less likely to have a decrease in FEV1 of more than 10% of their mean FEV1 compared to patients without Roflumilast (OR = 0.2; 95% CI 0.08–0.5). Escalation of therapy was documented in 49/97 (51%) of ambulatory visits for patients taking Roflumilast compared to 100/144 (69%) for patients without Roflumilast (OR = 0.45; 95% CI 0.26–0.76). Conclusions: Sarcoidosis patients receiving Roflumilast had less lung function loss and were less likely to require therapy escalation. Roflumilast could be a therapeutic option in sarcoidosis. Full article

Background: Transjugular intrahepatic portosystemic shunt (TIPS) has emerged as a feasible therapeutic option for cirrhotic patients with portal vein thrombosis (PVT). This study aimed to assess the long-term outcomes and factors associated with TIPS dysfunction in cirrhotic patients with PVT over an 18-year period in our institution. Methods: A retrospective study was conducted at Hospital Universitario Reina Sofía (Córdoba, Spain), including adult and pediatric cirrhotic patients with PVT who underwent TIPS between January 2006 and December 2024. Patient characteristics, procedural techniques, and clinical outcomes were evaluated. The primary outcomes were TIPS insertion success rate, primary patency, and dysfunction (stenosis or occlusion). Bivariate comparisons, logistic regression and receiver-operating characteristic (ROC) analyses were performed to identify potential predictors of TIPS dysfunction. Survival analyses using the Kaplan–Meier method and log-rank test, complemented by Cox regression, were also conducted. Results: A total of 36 patients (mean age, 44.8 ± 20.1 years old; 22.2% women; 19.4% children) were included, with a mean follow-up of 66.3 ± 45.9 months and nine deaths (one attributable to the procedure). The primary success rate of TIPS placement was 100%, and mean primary patency was 40.3 ± 40.2 months. TIPS dysfunction occurred in 30.3% of patients. Logistic regression identified age as the only significant predictor of TIPS dysfunction (OR = 0.949; 95%CI, 0.907–0.985, p = 0.011). ROC analysis demonstrated an AUC of 0.737 (95%CI, 0.547–0.927), with an optimal age cut-off of 21 (equivalent to 18 years; sensitivity = 91.3%, specificity = 50%). When age was dichotomized into adult versus pediatric groups, the OR was 0.095 (95%CI, 0.011–0.560), consistent with survival analyses (log-rank p = 0.007; HR = 4.85; 95%CI 1.36–16.88, p = 0.015). Conclusions: TIPS is an effective treatment for cirrhotic patients with PVT, achieving high technical success and long-term patency. However, it is not exempt from complications, including death, and potential dysfunction remains a concern, particularly in pediatric patients. Further prospective studies with larger cohorts are warranted to refine patient selection and optimize outcomes. Full article

Sarcopenia, the loss of skeletal muscle mass and function, is a common and critical comorbidity in patients with conditions frequently managed by interventional radiologists, such as liver cirrhosis and hepatocellular carcinoma (HCC). Interventional radiologists are well positioned to incorporate opportunistic screening for this condition during routine preprocedural cross-sectional imaging. This review summarizes the current evidence on how sarcopenia influences patient outcomes and informs procedural planning across a spectrum of interventional radiology (IR) procedures. In transarterial embolizations for HCC, sarcopenia is a robust independent predictor of increased mortality, with meta-analyses suggesting it may also predict a lower tumor response rate. Even earlier stages of muscle loss (pre-sarcopenia) are associated with worse survival, and dynamic changes in muscle mass post-treatment can serve as a biomarker for tumor progression. For patients undergoing transjugular intrahepatic portosystemic shunt, pre-procedural sarcopenia and myosteatosis are strong, independent predictors of both mortality and the development of post-procedural hepatic encephalopathy, with the presence of both conferring the highest risk. In the context of pre-surgical portal vein embolization, sarcopenia is consistently associated with impaired volumetric liver growth, although this does not always translate to worse short-term surgical outcomes, as functional liver regeneration may be preserved. Following percutaneous liver tumor ablation, sarcopenia is a powerful predictor of overall mortality, while its role in predicting tumor recurrence remains an area of active investigation. Finally, in non-oncologic interventions for peripheral arterial disease, sarcopenia is highly prevalent and is associated with worse functional status, higher mortality, and a significantly increased risk of major amputation after endovascular therapy. In conclusion, sarcopenia is a powerful and readily available biomarker that provides crucial prognostic information—often independent of standard clinical scores—across a wide spectrum of IR procedures. The consistent evidence supports integrating sarcopenia evaluation into routine practice to enhance risk stratification, improve patient counseling, and guide multidisciplinary treatment planning. Full article

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain limited. Objective: The objective of this study was to describe a single healthcare system’s implementation and early experience with an AI-enabled triage tool for pulmonary embolism patients across a multi-hospital network. Methods: This retrospective observational study evaluated the deployment of an AI-based clinical decision support system within a healthcare network. The AI tool detected PE and right ventricular (RV) strain and alerted the PE response team (PERT) to facilitate timely transfer and intervention. Three cohorts were evaluated: pre-AI, Year 1 post-AI, and Year 2 post-AI. Outcomes included transfer volumes, advanced therapy rates, and hospital length of stay (LOS). Results: A total of 183 PE transfer patients were analyzed: 36 pre-AI, 72 in Year 1 post-AI, and 75 in Year 2 post-AI. Transfers increased by 100% in Year 1 (p = 0.0005) and 108% in Year 2 (p = 0.011) compared to pre-AI. Catheter-based thrombectomy increased from 10 pre-AI to 18 in Year 1 (+80%, p < 0.0001) and 28 in Year 2 (+180%, p = 0.0006). After-hours diagnosis rose from 69.4% pre-AI to 70.8% in Year 1 (p = 0.027) and 77.3% in Year 2 (p = 0.088). Surgical embolectomy showed a borderline increase in Year 2 (p = 0.04), though case numbers were small. Conclusions: Implementation of an AI-assisted triage platform for PE was associated with sustained increases in interhospital transfers and advanced interventions, and a reduction in hospital length of stay. These findings support the potential for AI to standardize and expedite acute PE care in a multi-hospital health system. Full article

We report on a 6-year-old boy with underlying hypoplastic left heart syndrome and a total cavopulmonary connection (Fontan circulation) with a diagnosis of plastic bronchitis. After an initial good response to therapy, his productive cough became significantly stronger again. Four months later, the patient’s mother brought a preserving jar containing an extensive bronchial cast to the clinic, the size of which is rarely seen in small children. Plastic bronchitis is a rare but dreaded complication in patients with Fontan circulation as well as in infectious or inflammatory diseases; its treatment is challenging. Full article

Background/Objective: This study aims to better characterize the clinical presentation, histology, and imaging features of breast sarcomas on mammography, ultrasound, and MRI, in addition to analyzing the effectiveness of AI DS in detecting breast sarcomas. Methods: A retrospective review from 2008–2024 yielded 18 patients with histologically proven breast sarcomas with imaging available for review. Mammography was available for 13 lesions, ultrasound for 19 lesions, and MRI for 9 lesions. Imaging features were classified according to the BI-RADS 5th edition lexicon. Images were reviewed by two radiologists, and consensus was obtained regarding imaging features. AI DS was retrospectively applied to the breast masses identified on ultrasound. Data analysis was performed using descriptive statistics. Results: 17 females and 1 male were included in this study. Mammographic findings varied from solitary masses (3/13 [23.1%]), asymmetries (3/13 [23.1%]), architectural distortion (1/13 [7.7%]), skin thickening (3/13 [23.1%]), focal asymmetry with calcifications (1/13 [7.7%]), or no suspicious findings (2/13 [15.4%]). Sonography often revealed masses with an irregular shape (13/16 [81.2%]), non-circumscribed margins (15/16 [93.7%]), hypoechoic echo pattern (10/16 [62.5%]), and vascular flow (12/16 [75%]). MRI showed heterogeneously enhancing masses (6/9 [66.7%]) or isolated skin enhancement (3/9 [33.3%]). AI DS analyzed 16 masses on ultrasound and identified 15 (93.8%) as suspicious. Conclusions: Breast sarcomas had a variable appearance on breast imaging, ranging from a solitary mass to isolated skin findings. Awareness of how breast sarcomas can present across imaging modalities while using AI DS as an aid may help radiologists in making the correct diagnosis of this rare and aggressive disease. Full article

Background/Objectives: Genicular artery embolization (GAE) is an emerging, minimally invasive treatment for symptomatic osteoarthritis. This study assesses global online search trends for GAE compared with traditional knee replacement using Google Trends data. Methods: This retrospective observational study analyzed global search trends for osteoarthritis treatments using the publicly accessible Google Trends platform. Monthly relative search volumes (RSV; scaled 0–100) for English-language queries were retrieved from January 2018 to December 2024. Three emerging minimally invasive terms (“genicular artery embolization”, “knee embolization”, “interventional radiology”), and three traditional surgical terms (“knee arthroplasty”, “knee replacement”, “total knee replacement”) were included. Temporal trends were evaluated using linear and non-linear regression models, with model fit evaluated using coefficients of determination (R²), ANOVA, and accuracy measures. Statistical significance was defined as p < 0.05. Results: GAE-related terms demonstrated significant growth over time. “Genicular artery embolization” increased by 0.9% per month (R² = 0.795, p < 0.001), and “knee embolization” increased at 0.9% per month (R² = 0.627, p < 0.001) in a linear model. Traditional terms showed slower growth rates of 0.13–0.23% per month (R² = 0.159–0.271). Exponential and quadratic models confirmed these patterns. Mean RSV values over the study period were higher for traditional procedures (e.g., “total knee replacement”: 83.13) than for GAE-related terms (e.g., “genicular artery embolization”: 22.5). Conclusions: Global online interest in GAE-related terms is increasing at a substantially faster rate than interest in traditional knee replacement. Rapidly growing search interest highlights the need for accurate and accessible online patient education regarding emerging treatments. Full article

Background/Objectives: The aim of this study was to evaluate the prevalence of incidental findings in thoracic computed tomography (CT) performed because of COVID-19 and their potential impact on patient management. Methods: This retrospective analysis included 683 CT scans from 327 patients who underwent CT imaging of the thorax with or without the application of intravenous contrast-agents because of the primary indication of COVID-19. Radiological findings were categorized according to the COVID-19 Pneumonia Imaging Classification by four independent readers. Incidental findings were categorized according to a scale ranging from 0 (no patient impairment) to 3b (severe permanent impairment). Results: In the 683 CT-scans, typical COVID-19 findings were present in 273 scans (40.0%), atypical signs in 97 (14.2%), indeterminate findings in 40 (5.9%), and no signs of COVID-19 in 273 (40.0%). Incidental findings were reported in 93 out of 683 cases (13.6%), of which 63 (67.0%) were classified as category 0, 12 (12.8%) as category 1, 9 (9.6%) as category 2a, none (0.0%) as category 2b, 5 (5.3%) as category 3a, and 5 (5.3%) as category 3b. Conclusions: CT scans of the thorax for COVID-19 show a small but significant number of incidental findings that require further investigation. Full article

Oligometastatic breast cancer represents an intermediate state between localized and disseminated disease with reasonable potential for clinical cure. Advancements in surgery, radiotherapy, and systemic therapy have improved prognosis. Due to the high prevalence of bone metastases, an increasing number of studies are evaluating new treatment strategies for oligometastatic bone disease. The decision to perform skeletal surgery is complex and depends on optimal patient selection. Major criteria include impending or pathologic long bone fractures, severe neurologic compromise, and an expected survival of over 3 months. Factors associated with improved survival include solitary bone metastases, preserved performance status, adequate surgical margins, absence of pathologic fracture, metachronous metastases, and ER-positivity status. Radiotherapy, especially SBRT, offers effective local control and palliation. Interventional radiology techniques such as percutaneous thermal ablation have also been described as potential treatment alternatives, particularly for fragile patients. Systemic treatment varies according to the tumor subtype. For HR+ and HER2 subtypes, a combination of endocrine therapy with CDK4/6 inhibitors may be considered. HER2+ patients are often treated with HER2-targeted therapies combined with chemotherapy. For triple-negative breast cancer, chemotherapy is the primary treatment. Bone-modifying agents are also recommended to maintain bone strength, prevent skeletal-related events, and reduce the need for additional interventions. Skeletal muscle metastases in breast cancer patients are rare and typically indicate advanced disease with poor prognosis. Treatment options include chemotherapy, radiotherapy, and surgical excision, but should be tailored to the patient’s clinical condition and prognosis. Full article

Objectives: This study aims to report on radial access for transarterial chemoembolization (TACE), comparing right and left accesses in terms of technical effectiveness, safety, operator radiation exposure, and procedural comfort. Methods: In a single-center prospective design, patients were randomized into two groups according to right (R) or left (L) radial access. Primary endpoints were used to assess the efficacy and safety of radial access to perform liver TACE interventions; secondary endpoints were used to compare procedural comfort and operator radiation exposure. Technical efficacy was intended as procedural accomplishment via sole radial access. Safety was assessed in terms of complication occurrence. Operator radiation exposure was monitored according to dosimeters and beam-on time. Patient and operator procedural comfort was investigated using a visual analog scale. Results: A total of 61 patients (17 women and 44 men; mean age 68.4 years) were enrolled. Group R included 32 patients, and group L had 29; all were affected by hepatocellular carcinoma and treated with palliative or bridge-to-transplant intent. Sixteen (26.2%) had abnormal coagulation function. Technical success did not statistically differ between the two groups (96.8% group R vs. 100% group L). No major complications were recorded. While no differences were detected in terms of radiation exposure values and patient comfort, operators were significantly in favor of the right radial artery. Conclusions: In this sample, both right and left radial access were technically effective and safe, without significant differences in operator radiation exposure and patient comfort; considering significantly higher operator comfort with the right approach, right radial artery could be considered the right radial access for liver TACE interventions. Full article

Prostate cancer is one of the leading causes of cancer-related morbidity and mortality worldwide, and imaging plays a critical role in its detection, localization, staging, treatment, and management. The advent of artificial intelligence (AI) has introduced transformative possibilities in prostate imaging, offering enhanced accuracy, efficiency, and consistency. This review explores the integration of AI in prostate cancer diagnostics across key imaging modalities, including multiparametric MRI (mpMRI), PSMA PET/CT, and transrectal ultrasound (TRUS). Advanced AI technologies, such as machine learning, deep learning, and radiomics, are being applied for lesion detection, risk stratification, segmentation, biopsy targeting, and treatment planning. AI-augmented systems have demonstrated the ability to support PI-RADS scoring, automate prostate and tumor segmentation, guide targeted biopsies, and optimize radiation therapy. Despite promising performance, challenges persist regarding data heterogeneity, algorithm generalizability, ethical considerations, and clinical implementation. Looking ahead, multimodal AI models integrating imaging, genomics, and clinical data hold promise for advancing precision medicine in prostate cancer care and assisting clinicians, particularly in underserved regions with limited access to specialists. Continued multidisciplinary collaboration will be essential to translate these innovations into evidence-based practice. This article explores current AI applications and future directions that are transforming prostate imaging and patient care. Full article

Background: Combined Pulmonary Fibrosis and Emphysema (CPFE) is a distinct syndrome characterized by upper-lobe emphysema and lower-lobe fibrosis, predominantly in older male smokers. Despite often preserved spirometric volumes, patients exhibit severely reduced diffusing capacity and high susceptibility to complications, including pulmonary hypertension (PH), acute exacerbations, and lung cancer, contributing to poor prognosis. Purpose: This review aims to synthesize current evidence on CPFE, focusing on clinical phenotype, functional impairment, differential diagnosis, complications, and emerging management strategies, highlighting distinctions from idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). Methods: A narrative review of observational cohorts, retrospective series, and clinical studies examining CPFE patients was performed. Data on demographics, smoking history, symptomatology, pulmonary function, radiology, comorbidities, complications, and treatment approaches were extracted and integrated. Results: CPFE affects mainly males aged 65–70, with >90% reporting > 40 pack–years smoking history. Dyspnea is the cardinal symptom (>95%), often disproportionate to preserved FVC and TLC, accompanied by chronic cough in 30–70%. Exercise-induced desaturation is frequent, correlating with PH, observed in 47–90% of patients. Pulmonary function tests reveal preserved volumes, normal or near-normal FEV1/FVC, and severely reduced DLCO (35–45%), distinguishing CPFE from COPD and IPF. HRCT confirms the combined emphysematous and fibrotic pattern, critical for differential diagnosis. Acute exacerbations occur in 20–28% of cases, lung cancer in 22–46% (mostly squamous cell), and long-term oxygen therapy is required in >70%. Five-year survival is 35–55%, lower than emphysema alone and comparable or worse than IPF. Management focuses on smoking cessation, antifibrotics, oxygen therapy, and complication-specific treatments, and selected patients may undergo lung transplantation. Conclusions: CPFE is a clinically and functionally unique entity with a high burden of pulmonary and systemic complications. Accurate recognition using HRCT and DLCO, along with early intervention and tailored management, is essential to improve patient outcomes and guide prognostic stratification. Full article