Search Results (175)

Background/Objectives: This study aims to evaluate the additional value of [¹⁸F]F-fluorocholine ([¹⁸F]F-FCH) PET/CT over contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting the recurrence of brain metastases (BMs) after stereotactic radiosurgery (SRS) in patients with lung cancer brain metastases (LCBMs). Methods: Thirty-one patients with suspected recurrence of BM in LCBM after SRS were enrolled in this retrospective study. They underwent both [¹⁸F]F-FCH PET/CT and CE-MRI within 2 weeks. The tumor imaging parameters and clinical features were analyzed. The results of histopathology or radiographic follow-up served as the reference standard for the final diagnosis. Results: In these 31 patients, there were 54 lesions, of which 27 lesions were proven to be BM recurrence, while 27 lesions were non-recurrence. [¹⁸F]F-FCH PET/CT showed high radiotracer uptake in recurrent lesions of BM and identified 24 positive lesions (88.89% of sensitivity), while CE-MRI indicated 23 positive lesions (85.19% of sensitivity). [¹⁸F]F-FCH PET/CT indicated higher specificity (81.48%) and accuracy (85.19%) in detecting recurrence of BM than CE-MRI (40.74% and 62.96%, both p < 0.05), particularly in frontal lobes and cerebella. For lesion sizes, the accuracy of [¹⁸F]F-FCH PET/CT in detecting recurrent lesions was higher than that of CE-MRI for lesions over 1.0 cm but below 2.0 cm (p = 0.016). The detective performance of [¹⁸F]F-FCH PET/CT combined with CE-MRI was higher than [¹⁸F]F-FCH PET/CT or CE-MRI alone (all p < 0.05). Interestingly, TLC (≥4.11) was significantly correlated with poor intracranial PFS (iPFS), meaning it was a significant prognostic factor for iPFS. Conclusions: This study identified that compared with CE-MRI, [¹⁸F]F-FCH PET/CT demonstrated higher specificity and accuracy in diagnosing recurrence of BM in LCBM after SRS. Combining [¹⁸F]F-FCH PET/CT with CE-MRI has the potential to improve diagnostic performance for recurrence of BM and management of patient treatment. TLC was an independent risk factor for iPFS. Full article

Using neural networks has become the standard technique for medical diagnostics, especially in cancer detection and classification. This work evaluates the performance of Vision Transformer architectures, including Swin Transformer and MaxViT, for several datasets of magnetic resonance imaging (MRI) and computed tomography (CT) scans. We used three training sets of images with brain, lung, and kidney tumors. Each dataset included different classification labels, from brain gliomas and meningiomas to benign and malignant lung conditions and kidney anomalies such as cysts and cancers. This work aims to analyze the behavior of the neural networks in each dataset and the benefits of combining different image modalities and tumor classes. We designed several experiments by fine-tuning the models on combined and individual datasets. The results revealed that the Swin Transformer achieved the highest accuracy, with an average of 99.0% on single datasets and reaching 99.43% on the combined dataset. This research highlights the adaptability of Transformer-based models to various human organs and image modalities. The main contribution lies in evaluating multiple ViT architectures across multi-organ tumor datasets, demonstrating their generalization to multi-organ classification. Integrating these models across diverse datasets could mark a significant advance in precision medicine, paving the way for more efficient healthcare solutions. Full article

Pulmonary hypertension (PH) is broadly defined as a mean pulmonary arterial pressure (mPAP) exceeding 20 mm Hg at rest. Pulmonary arterial hypertension (PAH) is a specific subset of PH characterized by a normal pulmonary arterial wedge pressure (PAWP), combined with elevated mPAP and increased pulmonary vascular resistance (PVR), without other causes of pre-capillary hypertension such as lung diseases or chronic thromboembolic pulmonary hypertension. The majority of PAH cases are idiopathic; other common etiologies include connective tissue disease-associated PAH, congenital heart disease, and portopulmonary hypertension. To a lesser extent, genetic and familial forms of PAH can also occur. The pathophysiology of PAH involves the following four primary pathways: nitric oxide, endothelin-1, prostacyclin, and activin/bone morphogenetic protein (BMP). Dysregulation of these pathways leads to a progressive vasculopathy marked by vasoconstriction, vascular proliferation, elevated right heart afterload, and ultimately right-sided heart failure. Diagnosing PAH is challenging and often occurs at advanced stages. The gold standard for diagnosis remains invasive right heart catheterization. Along with invasive hemodynamic measurements, several noninvasive imaging modalities such as echocardiography and ventilation-perfusion scanning are key adjunct techniques. Also, recent advancements in cardiac magnetic resonance (CMR) have opened a new era for PAH management. Additionally, CMR and echocardiography not only enable diagnosis but also aid in evaluating disease severity and monitoring treatment responses. Current PAH treatments focus on targeting molecular pathways, reducing inflammation, and inhibiting right-sided heart failure. Integrating imaging with basic science techniques is crucial for enhanced patient diagnosis, and precision medicine is emerging as a key strategy in PAH management. Additionally, the incorporation of artificial intelligence into both molecular and imaging approaches holds significant potential. There is a growing need to integrate new imaging modalities with high resolution and reduced radiation exposure into clinical practice. In this review, we discuss the molecular pathways involved in PAH, the imaging modalities utilized for diagnosis and monitoring, and current targeted therapies. Advances in molecular understanding and imaging technologies, coupled with precision medicine, could hold promise in improving patient outcomes and revolutionizing the management of PAH patients. Full article

Objectives: Although hippocampal-sparing whole-brain irradiation (HS-WBI) offers potential neurocognitive benefits, it poses challenges in treatment planning. This study aimed to compare the dose distributions of biaxially rotational dynamic radiation therapy (BROAD-RT) with a novel O-ring-type linear accelerator (OXRAY) and conventional non-coplanar volumetric modulated arc therapy (VMAT) planning (Conv-VMAT) in HS-WBI treatment plans. Methods: This study included 10 patients with brain metastases from lung cancer at our institution. The hippocampus was contoured using gadolinium-based contrast-enhanced magnetic resonance imaging, and hippocampal-sparing regions were created using a 5 mm margin around the hippocampus. Two virtual plans (BROAD-RT and Conv-VMAT) with 30 Gy in 10 fractions were created to compare the dose distributions in the planning target volume (PTV), hippocampus, eyes, and lens. All plans were analyzed using a paired t-test. Results: The mean (standard deviation [SD]) hippocampus-Dmax, -Dmean, -D100%, and -V10 were 11.10 (0.61), 7.95 (0.20), 7.01 (0.19), and 0.42 (0.34) for BROAD-RT and 16.10 (0.57), 9.89 (0.75), 8.24 (0.34), and 39.05 (25.89) for Conv-VMAT, respectively. All hippocampal parameters were significantly better with BROAD-RT than with Conv-VMAT (p < 0.01). The PTV-D98, -D50, -D2, -V35, and -homogeneity index did not exhibit significant differences between BROAD-RT and Conv-VMAT. Although lens-Dmax was significantly better in BROAD-RT than in Conv-VMAT (p < 0.01), no significant differences were observed in the eye-Dmax and chiasm-Dmax between BROAD-RT and Conv-VMAT. The mean (SD) BROAD-RT beam delivery time was 313.60 (34.91) s. Conclusions: BROAD-RT improved hippocampal sparing with acceptable PTV coverage and PTV homogeneity in HS-WBI planning. In addition, BROAD-RT has a clinically acceptable treatment duration. Full article

Background: Testicular germ cell tumors (GCTs) are highly curable malignancies, particularly when diagnosed early. However, cardiac metastases are exceedingly rare—occurring in less than 1% of cases—and pose significant diagnostic and therapeutic challenges. Intracardiac involvement is exceptionally uncommon and typically necessitates a multidisciplinary approach for optimal management. Objective: To present a rare case of metastatic testicular GCT with intracardiac extension in a young male, underscoring the diagnostic complexity and therapeutic considerations of this unusual clinical scenario. Case Report: A 23-year-old male presented with diffuse abdominal pain, dyspnea, and a palpable right testicular mass. Imaging revealed a testicular tumor with metastases to the lungs, liver, retroperitoneal lymph nodes, and a large intracardiac mass extending from the inferior vena cava into the right atrium. Histopathology confirmed a mixed-germ cell tumor consisting of 75% seminoma, 20% embryonal carcinoma, and 5% teratoma. The patient underwent radical right orchiectomy followed by chemotherapy with the BEP regimen (bleomycin, etoposide, cisplatin). Cardiac magnetic resonance imaging confirmed the intracardiac mass, which significantly decreased in size after treatment. Serum tumor markers (AFP and β-hCG) also showed substantial post-treatment declines, corresponding with clinical improvement. Conclusions: This case highlights a rare presentation of metastatic testicular GCT with intracardiac involvement, emphasizing the importance of recognizing atypical metastases. Despite its complexity, the patient responded well to chemotherapy, reinforcing the effectiveness of current treatments. Long-term follow-up and a multidisciplinary approach are essential for monitoring recurrence and complications, contributing to the understanding of rare metastatic patterns and the need for further research. Full article

Real-time tumor-tracked radiotherapy with a linear accelerator-magnetic resonance (linac-MR) hybrid system requires accurate tumor delineation at a fast MR imaging rate. Various autocontouring methods have been previously evaluated against “gold standard” manual contours by experts. However, manually drawn contours have inherent intra- and inter-observer variations. We aim to quantify these variations and evaluate our tumor-autocontouring algorithm against the manual contours. Ten liver, ten prostate, and ten lung cancer patients were scanned using a 3 tesla (T) magnetic resonance imaging (MRI) scanner with a 2D balanced steady-state free precession (bSSFP) sequence at 4 frames/s. Three experts manually contoured the tumor in two sessions. For autocontouring, an in-house built U-Net-based autocontouring algorithm was used, whose hyperparameters were optimized for each patient, expert, and session (PES). For evaluation, (A) Automatic vs. Manual and (B) Manual vs. Manual contour comparisons were performed. For (A) and (B), three types of comparisons were performed: (a) same expert same session, (b) same expert different session, and (c) different experts, using Dice coefficient (DC), centroid displacement (CD), and the Hausdorff distance (HD). For (A), the algorithm was trained using one expert’s contours and its autocontours were compared to contours from (a)–(c). For Automatic vs. Manual evaluations (Aa–Ac), DC = 0.91, 0.86, 0.78, CD = 1.3, 1.8, 2.7 mm, and HD = 3.1, 4.6, 7.0 mm averaged over 30 patients were achieved, respectively. For Manual vs. Manual evaluations (Ba–Bc), DC = 1.00, 0.85, 0.77, CD = 0.0, 2.1, 2.8 mm, and HD = 0.0, 4.9, 7.2 mm were achieved, respectively. We have quantified the intra- and inter-observer variations in manual contouring of liver, prostate, and lung patients. Our PES-specific optimized algorithm generated autocontours with agreement levels comparable to these manual variations, but with high efficiency (54 ms/autocontour vs. 9 s/manual contour). Full article

Pediatric congenital lung malformations (CLMs) comprise a spectrum of developmental anomalies of lung parenchyma, airways, and vasculature. CLMs are increasingly diagnosed prenatally but remain best characterized by postnatal cross-sectional imaging. During pregnancy, ultrasound (US) and fetal magnetic resonance imaging (MRI) are commonly used to monitor lung lesions. Management of CLMs, including imaging, in infants and young children depends on associated symptoms and institutional standards. Chest CT angiography (CTA) is usually the most appropriate initial postnatal imaging modality for assessing prenatally diagnosed or clinically suspected CLMs in asymptomatic infants and children. Magnetic resonance (MR) imaging/magnetic resonance angiography (MRA) may be considered as a complementary, problem-solving, imaging modality for evaluation of CLMs during fetal and neonatal periods. This article presents contemporary perspectives on the imaging approach to pediatric patients with suspected CLMs and reviews up-to-date radiologic findings and clinical characteristics of CLMs. Full article

Quantification of the severity of chest wall deformation in children with spinal deformities is essential for understanding the effects on trunk appearance and cardiopulmonary function. Magnetic resonance imaging (MRI) is particularly valuable for this purpose, as it does not employ ionizing radiation and can provide three-dimensional (3D) imaging of thoracic anatomy. Acquiring sufficient quality images of the chest wall, lungs and airways at key stages of the respiratory cycle, such as end-inspiratory or expiratory phase, is crucial for accurately assessing chest wall deformation and pulmonary function and mechanics. Regarding image quality, low proton density and short relaxation times of the lung tissues result in poor quality images, and long acquisition times result in blurring caused by respiratory and cardiac motion. This overview summarizes strategies developed to address the inherent challenges of visualization of lung tissue and respiratory motion in MRI acquisition of the chest of pediatric patients with spinal deformities. An overview of the main methods for motion-resolved image acquisition and measurement of chest wall motion and thoracic volumes is presented and discussed. It is concluded that despite the development of multiple techniques and diverse strategies for obtaining high-quality, motion-resolved chest MRI, further validation of these methods is required before their implementation in clinics for routine evaluation of chest deformation in pediatric spinal deformity patients. Full article

Congenital diaphragmatic hernia (CDH) remains associated with high morbidity and mortality, primarily due to pulmonary hypoplasia and hypertension. Current antenatal diagnostic methods, such as ultrasound and magnetic resonance imaging (MRI), are unable to assess the severity of defects in lung and pulmonary vascular structures, which are critical determinants of the diverse phenotypes of CDH. Aberrant epigenetic regulation of lung development during gestation is believed to play a significant role in the pathogenesis of CDH. In this study, we aimed to identify miRNA patterns in amniotic fluid capable of categorizing CDH-fetuses for the personalized selection of effective treatment strategies at the antenatal and/or postnatal stages. Using deep sequencing and quantitative real-time polymerase chain reaction (PCR), we identified a set of miRNAs—miR-485-3p, miR-320b, miR-320a-3p, miR-221-3p, miR-200b-3p, miR-100-5p, miR-92a-3p, miR-30c-5p, miR-26a-5p, and let-7c-5p—whose reduced expression in amniotic fluid at 19–24 weeks of gestation allowed us to categorize fetuses with CDH into two distinct groups: one significantly different from the control group (non-CDH) and the other closely resembling it. Notably, no significant correlations were found between the content of these miRNAs in amniotic fluid and severity of lung hypoplasia assessed by ultrasound or MRI. However, there was significant positive correlation between the level of each of the miRNAs with that of miR-200b-3p, whose role in ensuring proper bronchopulmonary tissue structure during prenatal development—as well as its therapeutic potential for CDH-associated hypoplastic lungs—has been previously demonstrated. These findings lay the groundwork for the future development of genetically engineered drug formulations designed for antenatal endotracheal administration to correct abnormal miRNA levels in lung tissue and mitigate the progression of pulmonary hypoplasia and hypertension in CDH-fetuses. Full article

Linear accelerator–magnetic resonance (linac-MR) hybrid systems allow for real-time magnetic resonance imaging (MRI)-guided radiotherapy for more accurate dose delivery to the tumor and improved sparing of the adjacent healthy tissues. However, for real-time tumor detection, it is unfeasible for a human expert to manually contour (gold standard) the tumor at the fast imaging rate of a linac-MR. This study aims to develop a neural network-based tumor autocontouring algorithm with patient-specific hyperparameter optimization (HPO) and to validate its contouring accuracy using in vivo MR images of cancer patients. Two-dimensional (2D) intrafractional MR images were acquired at 4 frames/s using 3 tesla (T) MRI from 11 liver, 24 prostate, and 12 lung cancer patients. A U-Net architecture was applied for tumor autocontouring and was further enhanced by implementing HPO using the Covariance Matrix Adaptation Evolution Strategy. Six hyperparameters were optimized for each patient, for which intrafractional images and experts’ manual contours were input into the algorithm to find the optimal set of hyperparameters. For evaluation, Dice’s coefficient (DC), centroid displacement (CD), and Hausdorff distance (HD) were computed between the manual contours and autocontours. The performance of the algorithm was benchmarked against two standardized autosegmentation methods: non-optimized U-Net and nnU-Net. For the proposed algorithm, the mean (standard deviation) DC, CD, and HD of the 47 patients were 0.92 (0.04), 1.35 (1.03), and 3.63 (2.17) mm, respectively. Compared to the two benchmarking autosegmentation methods, the proposed algorithm achieved the best overall performance in terms of contouring accuracy and speed. This work presents the first tumor autocontouring algorithm applicable to the intrafractional MR images of liver and prostate cancer patients for real-time tumor-tracked radiotherapy. The proposed algorithm performs patient-specific HPO, enabling accurate tumor delineation comparable to that of experts. Full article

Calcified lung nodules are frequently encountered on chest imaging, often as incidental findings. While calcifications are typically associated with benign conditions, they do not inherently exclude malignancy, making accurate differentiation essential. The primary diagnostic challenge lies in distinguishing benign from malignant nodules based solely on imaging features. Various calcification patterns, including diffuse, popcorn, lamellated and eccentric, provide important diagnostic clues, though overlap among different conditions may persist. A comprehensive diagnostic approach integrates clinical history with multimodal imaging, including magnetic resonance and nuclear medicine, when necessary, to improve accuracy. When imaging findings remain inconclusive, tissue sampling through biopsy may be required for definitive characterization. This review provides an overview of the imaging features of calcified lung nodules, emphasizing key diagnostic challenges and their clinical implications. Full article

Tuberculous meningoencephalitis is a rare manifestation of Mycobacterium tuberculosis (Mtb), with the most severe form and highest mortality. It can cause multiple complications, and treatment is difficult, as drugs cannot properly diffuse through the haemato-encephalitic barrier. We reported the case of a 17-year-old female patient who was admitted to the emergency room department with a fever for previous two weeks (up to 39 °C), dizziness, difficulty walking, and weight loss. Magnetic resonance imaging indicated possible meningoencephalitis, and a CT scan of the lungs visualised miliary infiltrates in both lungs. After repeated tests, Mtb DNA was found in the bronchial wash, cerebrospinal fluid, faeces, and urine via an Xpert/Rif Ultra test. Treatment was started with isoniazid, rifampicin, ethambutol, pyrazinamide, and corticosteroids as well. Although treatment was initiated within the first few days in the hospital, a reduction in glucocorticoid dosage worsened the patient’s neurological state, making treatment even more challenging. Prolonged use of glucocorticoids led to an improvement in the stage of the condition. Further, over time, the patient’s condition improved. Pulmonary infiltrations were not found after 2.5 months of starting therapy. Conclusions: Timely treatment is crucial for improving the prognosis of patients with miliary tuberculosis and tuberculous meningoencephalitis. Prompt recognition of symptoms and accurate diagnosis are essential to initiate effective treatment strategies. In this patient’s case, prolonged use of corticosteroids reduced neurologic complications, and ongoing treatment gradually improved the patient’s condition. Full article

Background: Lung cancer frequently metastasizes to the brain, liver, and adrenal glands with a significant negative prognostic impact on overall survival and quality of life (QoL). To optimize treatment and prognosis, adequate staging with the detection of distant metastases is crucial. The incidence of brain metastases in potentially resectable early-stage non-small cell lung cancer (NSCLC) is as low as 3%; hence, the need for preoperative brain imaging has been a constant matter of debate, especially in stage II. In stages III and IV NSCLC, neuroimaging is an essential part of staging. Methods: A systematic literature search was performed. Publications from 1999 to 2024, focusing on preoperative brain imaging (BI) in the staging of stages I–IV NSCLC, were included. Data extraction included study population characteristics, the modality of BI, the incidence of brain metastases (BMs), and the main outcomes of the studies. The final included studies were selected according to the PRISMA criteria. In the second step, guidelines on BI in NSCLC staging of major importance were identified and compared. Results: A total of 530 articles were identified, of which 25 articles were selected. Four prospective studies and 21 retrospective investigations were included. Most of the investigations focused on BI in the early stages. The main imaging modality for BI was magnetic resonance imaging (MRI), followed by computed tomography (CT). Besides the identified 25 studies, the most important internationally applied guidelines on brain imaging in the staging of NSCLC were reviewed. While some guidelines agree on preoperative BI in NSCLC stage III (Union for International Cancer Control—UICC eighth edition) patients, other guidelines recommend earlier BI starting from clinical stage II. All mentioned guidelines homogenously recommend BI in patients with symptoms suggestive of brain pathologies. Conclusions: BI in NSCLC staging is recommended in neurologically symptomatic patients suggestive of brain metastases as well as NSCLC patients with stage III disease. Neuroimaging in stage IA patients, as well as in pure GGO (Ground-Glass Opacity) lesions, was considered unnecessary. The predominantly applied imaging modality was ce-MRI (contrast-enhanced magnetic resonance imaging). Inconsistency exists concerning BI in stage II. The identification of prognostic factors for developing BM in patients with early-stage NSCLC could help to clarify which subgroup might benefit from preoperative BI. Full article

Background: The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving TFE3 gene fusion. This article also aims to review the literature to understand the characteristics of this rare type of renal tumor. Renal cell carcinoma (RCC) associated with Xp11.2 translocation/gene fusion TFE3 is a rare subtype of kidney cancer that was classified in 2016 as belonging to the family of renal carcinomas with MiT gene translocation (microphthalmia-associated transcription factor). The prognosis for these kidney cancers is poorer compared to other types. Methods: We present a case of a 66-year-old man with Virchow–Troisier adenopathy during physical examination, which raises the suspicion of infra-diaphragmatic tumor. The echocardiography highlighted a heterogeneous mass in the right cardiac cavities, and the abdominal ultrasound exam revealed a solid mass at the upper pole of the left kidney. Results: Following computed tomography, magnetic resonance imaging, PET-CT, and histopathological and immunohistochemical examinations, the patient was diagnosed with renal carcinoma with Xp11.2 translocation and TFE3 gene fusion. Conclusions: IVC thrombosis is often associated with neoplastic disease due to the procoagulant state of these patients, the most common malignancies related to IVC thrombosis being represented by RCCs (38%), genitourinary cancers (25%), bronchus and lung cancers, retroperitoneal leiomyosarcoma, and adrenal cortical carcinoma. Imaging methods play a crucial role in differential diagnosis, allowing for the localization of the primary tumor and assessment of its characteristics. Full article

Cardiac involvement in cancer is increasingly important in the diagnosis and follow-up of patients. A thorough cardiovascular evaluation using multimodal imaging is crucial to assess any direct cardiac involvement from oncological disease progression and to determine the cardiovascular risk of patients undergoing oncological therapies. Early detection of cardiac dysfunction, particularly due to cardiotoxicity from chemotherapy or radiotherapy, is essential to establish the disease’s overall prognostic impact. Comprehensive cardiovascular imaging should be integral to the clinical management of cancer patients. Echocardiography remains highly effective for assessing cardiac function, including systolic performance and ventricular filling pressures, with speckle-tracking echocardiography offering early insights into chemotoxicity-related myocardial damage. Cardiac computed tomography (CT) provides precise anatomical detail, especially for cardiac involvement due to metastasis or adjacent mediastinal or lung tumors. Coronary assessment is also important for initial risk stratification and monitoring potential coronary artery disease progression after radiotherapy or chemotherapeutic treatment. Finally, cardiac magnetic resonance (CMR) is the gold standard for myocardial tissue characterization, aiding in the differential diagnosis of cardiac masses. CMR’s mapping techniques allow for early detection of myocardial inflammation caused by cardiotoxicity. This review explores the applicability of echocardiography, cardiac CT, and CMR in cancer patients with extracardiac tumors. Full article