Search Results (10,940)

Due to the complex pore structure and strong heterogeneity of carbonate reservoirs, accurately characterizing reservoir properties remains a major challenge. Electrical imaging logs and nuclear magnetic resonance (NMR) logging are the essential techniques for analyzing reservoir pore structures and assessing fluid distribution. However, the high cost of NMR logging often limits its field application, resulting in sparse data coverage. To overcome this limitation, a pore spectrum model was constructed from electrical imaging logs, and corresponding pseudo-echo signals were generated. Through an optimized inversion algorithm, key parameters such as pseudo-NMR total porosity, fracture porosity, and other pore-structure-related parameters were extracted. These parameters, together with acoustic and density logs, as well as other derived logging features, were integrated to develop a comprehensive porosity prediction model based on support vector machines (SVMs). The model was applied to carbonate reservoirs in the Tarim Basin. For Well AT01, the average relative errors of the four-parameter SVM model and the full-parameter SVM model on the independent test set were 43.49% and 9.70%, respectively. The relative error of the full-parameter SVM model ranged from 4.40% to 15.30%, indicating improved prediction accuracy compared with direct use of pseudo-NMR-derived porosity. In addition, the full-parameter SVM model provided porosity estimates that were generally consistent with core-measured porosity in the locally calibrated test interval. These results suggest that integrating pseudo-NMR-derived pore-structure parameters with conventional logging features can improve porosity evaluation in complex carbonate reservoirs, especially when measured NMR logging data are limited. Full article

Pulmonary hypertension (PH) is a heterogeneous clinical syndrome in which similar haemodynamic abnormalities may arise from distinct vascular, cardiac, pulmonary, thromboembolic, and molecular mechanisms. This complexity limits the ability of conventional classifications and risk scores to fully capture individual disease trajectories and treatment responses. Artificial intelligence (AI) offers a framework for integrating clinical data, electrocardiography, multimodal imaging, invasive haemodynamics, biomarkers, and multi-omics information across the PH care pathway. This review summarises current applications of machine learning and deep learning in early detection, diagnostic referral, right-ventricular and pulmonary vascular phenotyping, molecular endotyping, risk stratification, and therapeutic decision support. Available studies show promising results for AI-assisted electrocardiographic screening, automated echocardiographic and cardiac magnetic resonance analysis, computed tomography (CT)-based phenotyping, and multimodal prognostic modelling. True multi-omics integration in PH remains limited to discovery studies and has not yet yielded externally validated endotype or treatment-response classifiers. Evidence maturity is task-dependent: screening and phenotyping span several PH groups, whereas validated risk tools, molecular endotyping, and pathway-directed therapy remain predominantly PAH-based, particularly in idiopathic/heritable PAH. However, most evidence remains retrospective, derives from selected referral populations, and lacks robust external or prospective validation. No AI-based model currently supports routine drug selection or autonomous clinical decision-making. Future progress will require harmonised multicentre datasets and standardised acquisition protocols, transparent and interpretable models, and prospective studies demonstrating meaningful clinical benefit. AI should therefore be viewed as an emerging decision-support tool that may strengthen precision medicine in PH while complementing clinical expertise across diagnosis, phenotyping, risk assessment, and therapeutic stratification pathways. Full article

Background: Hand osteomyelitis is an uncommon but potentially devastating infection associated with prolonged treatment, repeated surgical interventions, and risk of amputation. Owing to its rarity, evidence regarding prognostic factors and optimal management remains limited. This study aimed to evaluate the clinical characteristics, microbiological findings, treatment strategies, and outcomes of patients with hand osteomyelitis, with particular emphasis on the association of admission inflammatory markers, immunosuppression, and preoperative magnetic resonance imaging (MRI). Methods: A retrospective single-center cohort study was performed over a 11-year period at a tertiary referral hospital. Patients with clinically and/or histopathologically confirmed hand osteomyelitis were identified using ICD-10-GM codes. Demographic characteristics, etiology, microbiological and histopathological findings, laboratory parameters, imaging, surgical treatment, antibiotic therapy, and length of hospital stay were reviewed. Correlations between admission C-reactive protein (CRP), leukocyte count, number of surgical procedures, and hospital stay were analyzed using Pearson’s correlation coefficient. Results: Fourteen patients were included (mean age, 53.7 years; 64.3% female). Osteomyelitis predominantly affected the distal phalanx (92.9%). Immunosuppression or immunocompromising comorbidities were present in 64.3% of patients. Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Streptococcus pyogenes were the most frequently isolated pathogens, while immunosuppressed patients exhibited more polymicrobial infections. The mean admission CRP was 87.8 mg/L and was markedly higher in immunosuppressed than in non-immunosuppressed patients (128.5 vs. 14.6 mg/L). Amputation was required in 78.6% of patients, with a mean of 3.3 surgical procedures per patient. Admission CRP is associated with both length of hospital stay (r = 0.61) and number of surgical procedures (r = 0.73), whereas leukocyte count showed only weak correlations. Patients who underwent MRI had a shorter mean hospital stay than those without MRI (13.4 vs. 19.6 days). The mean duration of antibiotic therapy was 29.3 days. Conclusions: In this small cohort, admission CRP showed a potential association with disease severity in hand osteomyelitis, with higher levels observed in patients requiring more extensive surgical treatment and longer hospitalization. MRI was associated with a shorter hospital stay, suggesting a possible role of early advanced imaging in facilitating timely diagnosis and treatment planning. Immunosuppressed patients tended to exhibit higher inflammatory markers and more frequently polymicrobial infections, although these findings should be interpreted cautiously given the limited sample size. Overall, these observations are exploratory and require confirmation in larger, preferably prospective studies. Full article

Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) is widely used in prostate cancer diagnosis, but biopsy findings may still underestimate tumor aggressiveness. This study evaluated the association of Prostate Imaging Reporting and Data System (PI-RADS) assessment with clinically significant prostate cancer (csPCa) and histopathological upgrading after radical prostatectomy. Methods: The retrospective analysis comprised 564 patients who underwent mpMRI–transrectal ultrasound fusion-guided biopsy followed by radical prostatectomy between 2021 and 2025. All included patients subsequently underwent radical prostatectomy, so the cohort represents a surgically selected population. Clinical variables, PI-RADS score, biopsy ISUP Grade Group, and final prostatectomy pathology were assessed. Clinically significant disease was defined as ISUP Grade Group ≥ 2. Histopathological upgrading was defined as an increase of at least one ISUP Grade Group between biopsy and final prostatectomy pathology. Results: csPCa was found in 385 patients (68.3%). Patients with csPCa had higher prostate-specific antigen density (PSAD) values than those without csPCa. PI-RADS score was significantly associated with csPCa and remained independently associated with csPCa in multivariable analysis. Histopathological upgrading occurred in 164 patients (29.1%), and PI-RADS score was also independently associated with upgrading. Model discrimination was limited. Conclusions: Preoperative mpMRI with PI-RADS assessment was associated with both csPCa and biopsy underestimation. Although PI-RADS was independently associated with both outcomes, its modest discriminatory performance indicates that it should be interpreted together with other clinical and pathological parameters rather than as a standalone predictive tool. Full article

This image report aims to illustrate the diagnostic value of integrating various diagnostic modalities to distinguish angiomatoid fibrous histiocytoma (AFH) from malignant soft tissue tumors. A 33-year-old man presented with a painful palpable mass in the medial left thigh. Magnetic resonance imaging revealed a 27 × 23 × 20 mm intramuscular lesion in the vastus medialis with a mixed T1 signal, predominantly high T2/STIR signal, internal hyperintense foci, a capsule-like rim, septations, heterogeneous enhancement, and marked peritumoral edema extending beyond the apparent tumor margins. Because these findings raised concern for a malignant soft tissue tumor, wide excision was performed after biopsy suggestive of low-grade sarcoma. Histologically, the tumor comprised spindle to epithelioid cells arranged in fascicular and storiform patterns surrounded by a lymphoid cuff. Immunohistochemistry showed positivity for CD68, CD99, and EMA, partial desmin and S-100 expression, and a Ki-67 index of 15%. Differential diagnosis included AFH and a malignant peripheral nerve sheath tumor. FISH demonstrated EWSR1 rearrangement, while PCR testing for EWSR1–CREB1 and EWSR1–ATF1 was negative. Although the specific fusion partner could not be identified, an EWSR1 rearrangement, together with the histologic and immunohistochemical findings, was considered supportive but not definitive for AFH. AFH, a rare intermediate tumor with nonspecific imaging features and variable pathology, makes diagnosis challenging. This case emphasizes the need to consider AFH in the diagnosis of intramuscular tumors with disproportionate peritumoral edema and highlights the role of molecular analysis in confirming the diagnosis. Full article

Background/Objectives: Horizontal aorta, characterized by a high aortic angle, represents a challenging anatomical feature during transcatheter aortic valve replacement (TAVR), but its association with cerebral ischemic injury remains unclear. This study investigated the association between horizontal aorta and diffusion-weighted magnetic resonance imaging (DW-MRI)-detected cerebral infarctions after TAVR. Methods: We retrospectively enrolled 411 consecutive patients with severe aortic stenosis undergoing transfemoral self-expanding TAVR between March 2017 and May 2022. Aortic angle was defined as the angle between the aortic annular plane and the horizontal plane on preprocedural computed tomography, and horizontal aorta was defined as an aortic angle > 60°. Patients were categorized into horizontal aorta and non-horizontal aorta groups. The incidence, number, and volume of new DW-MRI lesions were compared between groups. Results: The median age was 74.0 years (interquartile range [IQR]: 69.0 to 79.0); 54.5% were male, and the median Society of Thoracic Surgeons score was 3.83% (IQR: 2.29 to 6.39). Horizontal aorta was present in 69 patients (16.8%). Procedural complications were infrequent and comparable between groups. Although the incidence of new cerebral infarctions was similar between groups (89.9% vs. 83.0%; p = 0.157), patients with horizontal aorta had more cerebral infarction lesions (median, 4.0 vs. 3.0; p = 0.031), larger total lesion volume (320.0 vs. 180.0 mm³; p = 0.017), and larger lesion volume per infarction (70.0 vs. 51.7 mm³; p = 0.036). Multivariable analysis identified horizontal aorta as an independent predictor of the number of post-TAVR cerebral infarctions. Conclusions: Horizontal aorta is relatively common among patients undergoing TAVR and is independently associated with a greater burden of DW-MRI-detected subclinical cerebral ischemic injury. Full article

Background/Objectives: Andersson lesions are uncommon discovertebral complications of ankylosing spondylitis and may be overlooked when a new mechanical pain pattern is attributed to chronic inflammatory disease. This report describes the diagnostic reasoning, operative decision-making, and short-term outcome of a severe lumbar lesion with three-column instability. Methods: A 38-year-old woman with a 15-year history of ankylosing spondylitis presented with progressive low-back pain, left L5 radiculopathy, and marked functional decline without major trauma. Radiographs, computed tomography, and magnetic resonance imaging were used to characterize the lesion and assess spinal instability and neural compression. A Cawley type E Andersson lesion at L4/5 with severe three-column instability was diagnosed. The patient underwent single-stage posterior–anterior circumferential reconstruction consisting of L4/5 decompression, long-segment L2-S2 fixation, anterior debridement, and tricortical iliac crest grafting. Results: A postoperative gastrocnemius intramuscular venous thrombosis was detected and treated with anticoagulation. At 3 months, the activity-related visual analog scale score improved from 8 to 1, the Oswestry Disability Index improved from 68% to 18%, independent ambulation was restored, and imaging showed stable instrumentation with progressive osseous bridging. At the latest 9-month telephone follow-up, the patient reported maintained pain relief, mobility, and daily function; no new imaging was available. Conclusions: A change from inflammatory to mechanical pain or the development of neurologic findings in ankylosing spondylitis should prompt targeted imaging for an Andersson lesion. In carefully selected patients with severe three-column instability and substantial anterior column deficiency, circumferential reconstruction may provide effective short-term stabilization and functional recovery. Because radiographic follow-up was limited to 3 months, definitive fusion and long-term construct durability cannot be established. Full article

Background: Herpes simplex encephalitis (HSE) is a rare but life-threatening infection of the central nervous system associated with high mortality and severe neurological sequelae. The diagnosis may be particularly challenging in patients presenting with atypical clinical or laboratory findings. Case presentation: An 85-year-old woman presented with progressive impairment of consciousness and generalized neurological deterioration. Initial neuroimaging suggested an acute ischemic stroke, whereas subsequent brain magnetic resonance imaging (MRI) demonstrated bilateral temporal and insular cortical abnormalities suggestive of encephalitis. Cerebrospinal fluid (CSF) analysis revealed no pleocytosis, and blood tests showed no markers of systemic inflammation during admission, which initially lowered the suspicion of infectious encephalitis. Although no inflammatory cells were detected in the routine CSF examination, polymerase chain reaction (PCR) testing confirmed infection with herpes simplex virus type 1 (HSV-1). Despite the prompt initiation of acyclovir after suspicion of encephalitis with MRI, together with corticosteroid therapy, anticonvulsants, and supportive treatment, the clinical course was fatal. Conclusions: This case highlights the diagnostic challenges associated with HSE, particularly in patients with normocellular CSF and radiological findings that may mimic other neurological conditions, including ischemic stroke. The absence of CSF pleocytosis does not exclude HSE, although the timing of CSF sampling should be considered when interpreting this finding. Early MRI and molecular CSF diagnostics remain essential for establishing an accurate diagnosis and ensuring timely treatment. Full article

Background: Dieterich disease, or avascular necrosis of the metacarpal head, is a rare condition predominantly affecting adolescents, with fewer than 60 reported cases. We report a rare presentation in a 59-year-old adult with multiple systemic comorbidities. Methods: A 59-year-old man with diabetes, hypertension, and chronic kidney disease presented with progressive right third metacarpophalangeal joint pain without prior trauma. Following radiographic and magnetic resonance imaging (MRI) evaluation, the patient underwent surgical curettage of the necrotic bone followed by autologous iliac cancellous bone grafting. Histopathological examination supported the diagnosis. Results: At the long-term nearly 5-year follow-up, the patient maintained complete symptom resolution, fully restored range of motion, and durable osseous graft integration without secondary collapse or osteonecrotic recurrence. Conclusions: Although most frequently described in adolescents, Dieterich disease should be considered in adults presenting with unexplained metacarpophalangeal joint pain, especially alongside vascular-compromising comorbidities. MRI serves as a valuable adjunct for early lesion detection when radiographs are inconclusive. In this patient, joint-preserving curettage with autologous bone grafting provided durable structural support and favorable long-term functional recovery. Full article

Magnetic resonance imaging (MRI) is universally recognized as the gold standard for evaluating anterior cruciate ligament (ACL) injuries. However, differentiating partial tears from complete ruptures using the standard sagittal plane remains a diagnostic challenge. The oblique coronal orientation of the ACL often leads to volume averaging artifacts and inaccurate interpretations. While axial imaging offers a favorable alternative, distal tears near the tibial attachment are frequently missed. This review synthesizes current concepts in the anatomical and radiological evaluation of the ACL and introduces the “Namaste sign,” a novel and proposed preliminary imaging marker observed on coronal MRI to help assess ACL integrity. Grounded in the distinct native double-bundle architecture of the ACL, the Namaste sign utilizes the coronal plane to evaluate the transverse relationship and physiological tension of the anteromedial and posterolateral bundles. In a normal knee, these bundles converge symmetrically from their distinct tibial footprints and maintain tight contact with the lateral femoral condyle, mimicking hands pressed together in a traditional “Namaste” gesture. This article details the anatomical basis of this sign, provides a systematic method for its identification, and illustrates how morphological variations such as “broken hands,” “absent hands,” “absent proximal hug,” or “separation of hands” may correspond to specific ACL lesions. As a preliminary conceptual marker, the Namaste sign is intended to serve as an educational adjunct to combined three-plane evaluation rather than a standalone diagnostic criterion. Notably, this sign is not applicable to postoperative ACL reconstructions. A preliminary pilot study of 50 cases utilizing thin-slice MRI (≤3 mm) demonstrated nearly 100% visibility of the sign, 98% diagnostic accuracy, and almost perfect inter-observer agreement between two radiologists with more than 10 years of experience (Cohen’s kappa = 0.92). However, future diagnostic studies with rigorous arthroscopic reference standards are required to establish its clinical performance and reliability in larger cohorts. Full article

Background/Objectives: Incomplete intertrochanteric proximal femur fractures pose a management dilemma regarding the choice between surgery and conservative care. This study compared radiographic and functional outcomes between surgical fixation and conservative treatment and evaluated whether immediate full weight-bearing (FWB) can be performed by conservatively managed patients. Methods: This is a retrospective cohort study of consecutive patients aged ≥ 60 who presented with MRI-confirmed incomplete intertrochanteric fractures at a tertiary trauma center and rehabilitation unit from 2010 to 2020. Clinical outcomes were compared between conservatively managed and surgically treated patients. The primary outcome was radiographic bone union at 3 months; the secondary outcomes included secondary displacement, mobility at discharge, hospital length of stay, and mortality at 3 months and 1 year. Results: Forty-two patients met the inclusion criteria: 10 were managed conservatively, and 32 were managed operatively. Baseline age and sex distributions were similar between groups. At 3 months post-injury, bone union rates were 100% in both groups, with no incidences of secondary displacement regardless of whether a course of protected weight-bearing was prescribed. Functional mobility at discharge and length of stay were comparable. Mortality at 3 months and 1 year did not differ significantly between groups. Conclusions: The preliminary findings of this retrospective cohort study demonstrated managing MRI-diagnosed incomplete intertrochanteric proximal femur fractures conservatively to be feasible. Despite the limited sample size, all included patients who were treated conservatively achieved bone union by 3 months without secondary displacement. Their clinical outcomes were also comparable to the outcomes of those who were treated with surgical fixation. However, given the small sample size and lack of randomization, further investigation is warranted before clinical application. Full article

Background/Objectives: Magnetic resonance imaging (MRI)-based image-guided adaptive brachytherapy (IGABT) is the preferred standard for cervical cancer, but access remains limited in many settings. Computed tomography (CT)-based IGABT provides a practical alternative. We evaluated clinical outcomes and prognostic factors following its routine implementation. Methods: This retrospective cohort study included patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I–IVA cervical carcinoma treated with definitive radiotherapy incorporating CT-based IGABT from January 2019 to December 2021. Patients received pelvic external beam radiotherapy (45–50.4 Gy in 23–28 fractions), with or without concurrent platinum-based chemotherapy, followed by four high-dose-rate brachytherapy fractions. Local control and overall survival were estimated using Kaplan–Meier analysis, and prognostic factors were evaluated using Cox regression. Results: Among 237 patients, 56.9% had FIGO stage III–IV disease, and hybrid intracavitary/interstitial brachytherapy was used in 30.2% of fractions. The mean high-risk clinical target volume D90 (HR-CTV D90) was 85.4 ± 2.7 Gy EQD₂. Median follow-up was 59.9 months for local control and 71.1 months for overall survival. The 5-year local control and overall survival rates were 84.4% (95% CI, 79.1–88.5%) and 62.9% (95% CI, 56.3–68.8%), respectively. Squamous histology was independently associated with improved local control and overall survival. HR-CTV D90 ≥ 85 Gy EQD₂ was associated with improved local control, whereas ≥4 chemotherapy cycles and overall treatment time ≤ 56 days were associated with improved overall survival. Conclusions: Routine CT-based IGABT achieved clinically meaningful outcomes despite the high proportion of advanced-stage disease. Achieving HR-CTV D90 ≥ 85 Gy EQD₂, delivering ≥4 chemotherapy cycles, and completing treatment within 56 days were associated with improved outcomes. Full article

Objective: Patients with prostate-specific antigen (PSA) levels in the 4–10 ng/mL gray zone present a diagnostic challenge, as PSA alone cannot reliably distinguish clinically significant prostate cancer (csPCa) from benign conditions or indolent disease, potentially leading to unnecessary biopsies or missed clinically significant disease. This study aimed to develop a risk prediction model for csPCa in this population using clinical indicators and magnetic resonance imaging (MRI) quantitative data, and to evaluate its potential value for risk stratification and as a supplementary tool for biopsy decision-making. Methods: We retrospectively included 210 patients with PSA levels in the 4–10 ng/mL range and confirmed pathological diagnoses, who were admitted to our hospital between January 2018 and June 2025. csPCa was defined as a Gleason score ≥ 7. Patients were stratified by pathological diagnosis (csPCa vs. non-csPCa) and randomly divided into training and internal validation sets in a 7:3 ratio. The following variables were collected for analysis: age, PSA, apparent diffusion coefficient (ADC), and relative T2 value. Univariate and multivariate logistic regression were used to identify independent predictors of csPCa. We constructed a prediction model and nomogram. The discriminating ability, calibration, and stability of the model were assessed using receiver operating characteristic (ROC) curves, calibration curves, and Bootstrap internal validation. Decision curve analysis (DCA) was performed to evaluate the model’s net benefit across clinically relevant threshold probabilities. Risk stratification was performed based on predicted probabilities. Results: Of the 210 patients, 50 had csPCa and 160 had non-csPCa lesions. Univariate regression showed associations between age, ADC value, and relative T2 value. Multivariate logistic regression identified age and relative T2 value as independent predictors in the final model. Internal validation using 1000 Bootstrap resampling with optimism correction yielded a corrected AUC of 0.698 (95% CI: 0.669–0.716), with a mean optimism of only 0.016, indicating minimal overfitting. The area under the curve (AUC) of the model was 0.720 in the training set and 0.711 in the validation set. The calibration curve for the training set demonstrated good agreement between predicted and observed probabilities. DCA showed net benefits across certain threshold probabilities. Risk stratification based on predicted probability showed csPCa detection rates of 14.7%, 28.3%, and 47.4% in low-, intermediate- and high-risk groups, respectively. Conclusions: The logistic binary classification model based on age and relative T2 value may assist in risk assessment for csPCa in PSA gray zone patients. However, its moderate discrimination suggests it should be used as a supplementary tool rather than a standalone diagnostic test. Risk stratification based on predicted probability may help identify different csPCa risk populations, but given the exploratory nature of this single-center retrospective study, multi-center, large-sample, and prospective studies are required for external validation and optimization before clinical implementation. Full article

Background: Worry proneness has been proposed to influence uncertainty processing; however, its neural mechanisms during different forms of uncertain decision-making remain poorly understood. This study used functional magnetic resonance imaging (fMRI) to investigate behavioral and neural responses associated with risky and ambiguous decision-making and to examine how individual differences in worry proneness relate to uncertainty-related neural processing. Methods: Participants completed a modified ambiguity–risk decision-making task during fMRI scanning. Whole-brain, region-of-interest (ROI), and continuous PSWQ-based correlation analyses were conducted to characterize neural responses associated with uncertainty type and individual differences in worry proneness. Results: Behavioral analyses revealed no significant effects of worry proneness or uncertainty type on gambling choices or reaction times. Whole-brain analyses showed that risky decisions elicited greater activation than ambiguous decisions in the right insula, right inferior parietal lobule, and left supramarginal gyrus, whereas ambiguous decisions preferentially recruited the right superior temporal gyrus. An exploratory peak-level interaction between worry proneness and uncertainty type was identified in the right middle frontal gyrus (BA6), with higher worry proneness associated with lower BA6 activation during risky decision-making. Continuous analyses further showed that BA6 activation during risky decisions was negatively correlated with PSWQ scores. ROI analyses demonstrated greater activation during risky than ambiguous decisions in the bilateral caudate nucleus, left insula, and right inferior frontal gyrus. Conclusions: These findings demonstrate that risky and ambiguous decision-making are associated with partially dissociable patterns of neural activation. Worry proneness was not associated with widespread alterations in behavioral performance or uncertainty-related neural responses; however, exploratory analyses identified localized associations between worry proneness and prefrontal neural responses during risky decision-making. These findings suggest that individual differences in worry proneness may be related to selective variation in specific neural processes rather than broad alterations in the neural systems supporting uncertainty processing. Full article

Background/Objectives: Medulloblastoma is the most common malignant pediatric brain tumor. Although radiotherapy improves survival, it is often associated with neurocognitive impairments affecting language and executive functions in developing brains. We investigated treatment-related changes in task-evoked activation using silent verb-generation functional magnetic resonance imaging (fMRI). Methods: Thirty-one children and adolescents with medulloblastoma enrolled on SJMB12 (18 males; mean age 14.1 ± 4.7 years) completed visual and auditory noun-cued covert verb generation during fMRI before radiotherapy and again within 6 weeks after completing radiotherapy. A two-stage, nested feature-selection framework coupled with a linear Support Vector Machine differentiated pre- from post-irradiation scans using fully nested leave-one-subject-out cross-validation, in which the sign-consistency threshold was re-selected within each training fold, and was evaluated against the 50% chance level of the paired forced-choice design. Results: In fully nested leave-one-subject-out evaluation, the pipeline correctly ordered the paired pre- and post-radiotherapy scans for 22 of 31 participants (71.0%; 95% CI, 52.0–85.8%; one-sided permutation p = 0.015). Descriptive cohort-derived mapping at the modal inner-loop sign-consistency threshold implicated reduced activity in bilateral cerebellar hemispheres (Crus I/II, lobules VI–VIII), left inferior frontal gyrus, left insula, left putamen, supragenual anterior cingulate, and left middle temporal gyrus. Reduced task-negative responses were observed in a large cluster overlapping right precuneus, right superior parietal, right paracentral, and right postcentral cortices, alongside increased engagement of the left supramarginal gyrus and left inferior parietal lobule. Conclusions: In this single-center pilot cohort, silent verb-generation fMRI detected early post-radiotherapy activation changes within cerebellar–cerebral language and control networks. These findings require independent validation, test–retest controls, and longitudinal neurocognitive outcomes before being interpreted as clinical biomarkers. Full article