Search Results (120)

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

China’s southwestern karst landscapes support remarkable cavefish diversity, especially within Sinocyclocheilus, the world’s largest cavefish genus. Using integrative taxonomic methods, we describe Sinocyclocheilus wanlanensis sp. nov., found in a subterranean river in Guizhou Province. This species lacks horn-like cranial structures; its eyes are either reduced to a dark spot or absent. It possesses a pronounced nuchal hump and a forward-protruding, duckbill-shaped head. Morphometric analysis of 28 individuals from six species shows clear separation from related taxa. Nano-CT imaging reveals distinct vertebral and cranial features. Phylogenetic analyses of mitochondrial cytb and ND4 genes place S. wanlanensis within S. angularis group as sister to S. bicornutus, with p-distances of 1.7% (cytb) and 0.7% (ND4), consistent with sister-species patterns within the genus. Sinocyclocheilus wanlanensis is differentiated from S. bicornutus by its eyeless or degenerate-eye condition and lack of bifurcated horns. It differs from S. zhenfengensis, its morphologically closest species, in having degenerate or absent eyes, shorter maxillary barbels, and pelvic fins that reach the anus. The combination of morphological and molecular evidence supports its recognition as a distinct species. Accurate documentation of such endemic and narrowly distributed taxa is important for conservation and for understanding speciation in cave habitats. Full article

Background/Objectives: Pelvic exenteration (PE) might be a curative option for patients with advanced pelvic malignancies. Due to its significant morbidity and mortality rates, PE necessitates meticulous patient selection, and a comprehensive understanding of disease spread. This study outlines the experience at a single tertiary referral center and investigates prognostic factors influencing survival post-PE, thereby guiding clinical decision-making processes. Methods: Patients undergoing PE for advanced pelvic gynecological malignancies between 01/2016 and 12/2023 were retrospectively analyzed using a prospectively managed database. Eligibility for PE was determined through individualized tumor board evaluations based on CT/MRI imaging, excluding patients with distant metastases. Baseline demographic and clinical characteristics, operative details, complication rates, and histopathological findings were assessed using univariate and multivariate regression analyses. Disease-free (DFS) and overall survival (OS) were assessed by Kaplan-Meier analysis. Poor outcome prognostic factors were identified, outlining an optimal candidate profile for PE. Results: A total of 70 patients were included. The median age was 54.5 years. Forty-three patients (61.4%) presented with recurrent disease and the majority were diagnosed with cervical cancer (n = 48, 68.6%). Total PE was performed in 40 patients (57.1%), with complete tumor resection achieved in 68.6% of patients (n = 48). Sixteen patients (22.8%) experienced grade IV/V complications. Median DFS and OS were 8.2 and 16.4 months, respectively. Multivariate analysis identified R1 resection status and para-aortic lymph node involvement as independent negative prognostic factors. Conclusions: PE is a viable option for selected patients with advanced primary and recurrent pelvic gynecological malignancies. When complete tumor resection is feasible, patients may derive benefit from PE, although the risk of severe perioperative complications must be carefully evaluated. Full article

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

Rectal cancer management necessitates a rigorous multidisciplinary strategy, emphasizing precise staging and detailed risk stratification to inform optimal therapeutic decision-making. Obtaining an accurate histological diagnosis before initiating treatment is essential. Comprehensive staging integrates clinical evaluation, thorough medical history analysis, assessment of carcinoembryonic antigen (CEA) levels, and computed tomography (CT) imaging of the abdomen and thorax. High-resolution pelvic magnetic resonance imaging (MRI), utilizing dedicated rectal protocols, is critical for identifying recurrence risks and delineating precise anatomical relationships. Endoscopic ultrasound further refines staging accuracy by determining the tumor infiltration depth in early-stage cancers, while preoperative colonoscopy effectively identifies synchronous colorectal lesions. In early-stage rectal cancers (T1–T2, N0, and M0), radical surgical resection remains the standard of care, although transanal local excision can be selectively indicated for certain T1N0 tumors. In contrast, locally advanced rectal cancers (T3, T4, and N+) characterized by microsatellite stability or proficient mismatch repair are optimally managed with total neoadjuvant therapy (TNT), which combines chemoradiotherapy with oxaliplatin-based systemic chemotherapy. Additionally, tumors exhibiting high microsatellite instability or mismatch repair deficiency respond favorably to immune checkpoint inhibitors (ICIs). The evaluation of tumor response following neoadjuvant therapy, utilizing MRI and endoscopic assessments, facilitates individualized treatment planning, including non-operative approaches for patients with confirmed complete clinical responses who comply with rigorous follow-up. Recent advancements in molecular characterization, targeted therapies, and immunotherapy highlight a significant evolution towards personalized medicine. The effective integration of these innovations requires enhanced interdisciplinary collaboration to improve patient prognosis and quality of life. Full article

Background/Objectives: The management of localized prostate cancer with regional lymph node involvement (N1M0) presents significant clinical challenges. While once considered indicative of systemic disease, improved imaging and evolving treatment paradigms have redefined node-positive disease as potentially curable. This systematic review aims to assess current evidence regarding treatment modalities and outcomes for patients with localized N1M0 prostate cancer. Methods: A systematic review was conducted to identify studies evaluating therapeutic strategies for N1M0 prostate cancer. Eligible studies included randomized controlled trials, retrospective analyses, and consensus guidelines. Treatment approaches reviewed included radical prostatectomy (RP) with pelvic lymph node dissection (PLND), whole pelvic radiotherapy (WPRT), prostate-only radiotherapy (PORT), androgen deprivation therapy (ADT), and metastasis-directed therapy (MDT), including stereotactic body radiotherapy (SBRT). Key outcomes included overall survival (OS), biochemical recurrence-free survival (bRFS), disease-free survival (DFS), and treatment-related toxicity. Results: Multimodal approaches—particularly the combination of ADT with WPRT or adjuvant radiotherapy following RP—were associated with improved survival outcomes. Patients with limited nodal burden and undetectable postoperative prostate-specific antigen (PSA) levels derived the most benefit. The use of prostate-specific antigen membrane positron-emission tomography/computed tomography (PSMA PET/CT) enhanced detection and guided MDT in oligorecurrent disease. SBRT, simultaneous integrated boost (SIB), and hypofractionated regimens demonstrated promising efficacy with acceptable toxicity profiles. Conclusions: Node-positive localized prostate cancer is optimally managed with individualized, multidisciplinary strategies. Combining systemic and locoregional treatments improves outcomes in selected patients. Ongoing prospective studies are warranted to refine patient selection, optimize treatment sequencing, and integrate novel imaging and systemic agents. Full article

In this article, we present a case of a 49-year-old woman presenting with a recurrent metastatic neuroendocrine tumor. Background: Insulinomas are neuroendocrine tumors derived from beta cells of the pancreas that secrete insulin. Usually, they are benign tumors; however, metastatic insulinomas are an extremely rare malignant form of these tumors, carrying a significantly worse prognosis. Case Presentation: A 49-year-old woman, a patient in the University Hospital in Wroclaw in the Department of Endocrinology, Diabetes and Isotope Therapy, first presented with abdominal pain in 2009, when ultrasound and further examination led to the diagnosis of a tumor in the pancreas (a solid pseudopapillary tumor of the pancreas—meta NET G2), and the patient underwent distal pancreatectomy with splenectomy. For ten years, she was under observation, and her symptoms, such as abdominal pain, nausea, weight loss, and general weakness, reappeared in 2019. Then, magnetic resonance imaging (MRI) showed a lesion in the liver, and further histopathology revealed neuroendocrine tumor (NET) metastasis to the liver. In 2022, the patient presented with loss of consciousness and convulsion, loss of weight, and hypoglycemia after meals. In April 2022, the daily glycemic profile was recorded and a 72 h fasting test was performed; however, their results excluded insulinoma. Positron emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (18F-FDG) and PET with gallium-68-DOTA-(Tyr3)-octreotate (68Ga-DOTA-TATE) showed a metastatic proliferative process in the liver. Persistent hypoglycemia led to another hospitalization in May 2022, and repeated tests allowed for the diagnosis of insulinoma. Treatment with somatostatin analogs and diazoxide was started. A CT scan in November 2022 and a PET scan in January 2023 showed new metastases to the liver, bones, and cervical lymph nodes, and it was decided to intensify the treatment. In May 2023, the patient was qualified for Lutathera treatment for insulinoma at the University Clinical Hospital in Poznań. In June 2023, another disturbing symptom was reported by the patient, a painful lump in the breast. During diagnostics, metastases with high proliferation markers were found in both breasts. Two months later, in August 2023, the patient received another dose of Lutathera. In October 2023, significant progression of liver lesions, metastases to bones of the spine, ribs, and pelvis, and periaortic and pelvic lymphadenopathy were found as well as elevated values of neuron-specific enolase and calcitonin. The patient was also referred to the Palliative Medicine Home Hospice. In consultation with the Lower Silesian Cancer Center, the decision was made to forgo further treatment with PRRT and initiate systemic chemotherapy. Despite the chosen treatment, the patient died on 27/DEC/2023. Conclusions: This case report can serve clinicians, as it presents a case of an extremely rare and insidious tumor, metastatic insulinoma. Full article

Deep learning (DL) techniques have demonstrated remarkable capabilities in recognizing complex patterns in medical imaging data. In recent years, DL has been increasingly applied in clinical medicine for disease diagnosis and progression prediction. This study aimed to develop and validate a DL model for detecting sacroiliitis using pelvic anteroposterior (AP) radiographs. We retrospectively analyzed 1853 patients with pelvic AP radiographs, including 3706 sacroiliac joints (SIJs). Pelvic AP radiographs served as input data for the DL model development, while the presence or absence of sacroiliitis confirmed by pelvic computed tomography (CT) was used as the reference standard output data. Based on CT findings, 1463 of 1853 right SIJs showed evidence of sacroiliitis, while 390 had no sacroiliitis. Similar findings were observed in the left SIJs. The dataset was split with 70% (1297 images) for training and 30% (556 images) for validation. The areas under the curve (AUC) for our DL model on the validation dataset were 0.871 (95% confidence interval (CI): 0.834–0.907) and 0.869 (95% CI: 0.834–0.907) for the left and right SIJs, respectively. Diagnostic accuracies for sacroiliitis on the left and right sides were 85.4% and 86.3%, respectively. These results demonstrate that a DL model trained on pelvic AP radiographs with CT-confirmed diagnoses can effectively aid in the diagnosis of sacroiliitis. Full article

Background/Objectives: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. Methods: A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov–Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. Results: A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. Conclusions: The Ramadanov–Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability. Full article

Background: This institutional, register-based analysis aimed to evaluate the feasibility of using CT-based sacral Hounsfield units (HUs) for assessing bone density in pelvic fragility fractures and to explore their potential correlation with DEXA measurements and osteological laboratory diagnostics. Methods: Patients aged > 80 years, admitted between 2003 and 2019 with pelvic ring fractures, were analyzed in this retrospective single-center study. CT scans were evaluated according to the classification of fragility fractures of the pelvis (FFPs), which guided treatment decisions (conservative or surgical). The diagnosis of a fragility fracture was based on both fracture morphology and patient history, including the presence of low-energy trauma. Bone health was assessed using standardized laboratory diagnostics including serum calcium, phosphate, alkaline phosphatase, and 25(OH)-vitamin D, in addition to DEXA scans and CT-derived Hounsfield units. Vitamin D levels and bone density evaluations were analyzed to identify possible correlations among these factors and with fracture patterns. Results: A total of 456 patients (mean age 87.3 years, 79.6% female) were included. The CT-based FFP classification identified Type II as the most common fracture type (66.7%). Conservative treatment was the predominant approach (84.9%). Serum 25(OH)-vitamin D deficiency was observed in 62.7% of the patients, while osteopenia and osteoporosis were found in 34.3% and 46.5% of cases, respectively. HU values at S1 showed significant correlation with femoral neck T-scores, highlighting the utility of CT scans for bone density assessment. Conclusions: This study emphasizes the complementary roles of CT-derived HU values and DEXA T-scores in evaluating bone quality and fracture severity in geriatric patients with FFP. While DEXA remains the gold standard, CT imaging offers valuable early insights, supporting the timely initiation of osteoporosis therapy. Given the high prevalence of fragility fractures in this age group, early CT-based screening may facilitate earlier initiation of osteoporosis-specific therapy, including anabolic agents where indicated. Further research is needed to explore the relationships between vitamin D levels, bone density assessments, and fracture types. Full article

Iatrogenic ureteral strictures are uncommon but challenging to manage. We present our expertise in laparoscopic and robot-assisted laparoscopic ureteroureterostomy (LUU and RAUU) for lumbar and iliac strictures and laparoscopic ureteral reimplantation for pelvic strictures. A descriptive study was conducted on nine adult patients who underwent minimally invasive procedures. Six had lumbar or iliac ureteral strictures—five due to ureterorenoscopy and one following pancreaticoduodenectomy for pancreatic cancer. Three developed pelvic strictures after ureterorenoscopy. Preoperative evaluation included a medical history review, abdominal ultrasound, and CT scan. Success was characterized by the absence of symptoms and the lack of obstruction on follow-up imaging at one year. All procedures were technically feasible, with a median operating time of 105 min and a median hospital stay of four days. No major complications occurred. One patient experienced ureteral stricture recurrence following a laparoscopic approach for a lumbar stricture, and required a permanent double-J stent. At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function. Our findings suggest that robotic and laparoscopic ureteral reconstruction performed by experienced surgeons at a tertiary center is a safe and effective option with a low complication rate. Full article

Background/Objectives: An 80-year-old man was admitted to our department after a salvage radical cystectomy for actinic cystitis due to radiotherapy for prostate cancer. He presented with a two-month history of feculent debris in the right stoma and deteriorated general conditions, after a long past medical history of recurrent complicated urinary infections. Methods: Computer tomography (CT) of the abdomen revealed a ureterocolic fistula along the right ureteral pelvic tract. A right percutaneous nephrostomy tube was placed. Due to multiple previous surgeries, several lines of intravenous antibiotic therapies and the overall condition of the patient, a conservative management was preferred. Results: A bovine serum albumin-glutaraldehyde (BioGlue^®) adhesive was inoculated into the right ureter through the stoma to close the fistula. After 24 months, the patient remained asymptomatic with negative follow-up imaging. Conclusions: Given the uniqueness of the management of a ureterocolic fistula, this case offers insight into conservative treatment in frail patients not suitable for major surgery. Full article

Background/Objectives: The accurate preoperative prediction of lymph node (LN) metastasis is essential to optimizing surgical management in renal pelvis urothelial carcinoma (RPUC) and ureteral urothelial carcinoma (UUC). This study evaluates the predictive value of preoperative computed tomography (CT) findings in detecting LN metastasis and determining primary metastatic LN location based on the tumor site. Methods: This retrospective study included 48 RPUC and 97 UUC patients who underwent surgery with lymph node dissection (LND) between 2005 and 2023. Preoperative CT images were assessed for tumor size, location, multifocality, peritumoral fat infiltration, hydronephrosis grade, LN status, and metastatic LN location. Logistic regression and receiver operating characteristic (ROC) curve analyses identified predictive factors for LN metastasis, while Pearson’s chi-square and Fisher’s exact tests determined the association between locations of LN metastasis and primary tumor sites after categorizing UUC into upper and lower UUC. Results: In RPUC, 13 of 48 patients had LN metastasis, with tumor size and peritumoral fat infiltration emerging as significant predictors (p < 0.05). In UUC, 39 of 97 patients had LN metastasis, with tumor size and hydronephrosis grade being significant predictors (p < 0.001). An optimal tumor size threshold of 4 cm was identified for predicting LN metastasis in UUC, and 4.4 cm for RPUC. Additionally, a hydronephrosis grade of 3 or higher was found to be a strong predictor in UUC. ROC analysis showed high accuracy, yielding an AUC of 0.907 in RPUC and 0.904 in UUC. Cross-validation supported the robustness of these findings. Primary LN metastatic sites were predominantly ipsilateral hilar nodes in RPUC and ipsilateral pelvic nodes in lower UUC (p < 0.001). Conclusions: Preoperative CT imaging provides a reliable, noninvasive tool for predicting LN metastasis in RPUC and UUC. Identifying key imaging-based predictors can facilitate risk stratification and surgical decision-making, particularly regarding the necessity and extent of LND. Full article

Background/Objectives: To evaluate dual-energy computed tomography (DECT) in comparison with conventional CT for periprosthetic bone and surrounding soft tissues in total hip arthroplasty (THA). Methods: Two authors independently screened titles and abstracts for eligibility, discussing any disagreements with a third author for final decisions. The articles were categorized into two main groups: those focusing on periprosthetic bone and those on blood vessels or pelvic organs. Results: A total of 37 articles were selected to be included in this systematic review. Conclusions: Our systematic review reveals significant variability in the use of DECT for periprosthetic bone and soft tissue imaging, due to differences in equipment, protocols, and clinical settings. While many studies indicate that virtual monochromatic imaging (VMI), especially when combined with metal artifact reduction (MAR), improves image quality, there is no consensus on optimal energy levels. Future research should focus on large-scale, multicenter studies with standardized protocols to compare reconstruction techniques, energy levels, and combined MAR-VMI use. Full article

Background: To determine and review the currently available literature behind the staging capabilities of 18F-PSMA-1007 PET/CT in the setting of initial staging and detection of recurrent disease for patients with prostate cancer. Prostate cancer (PCa), one of the most diagnosed malignancies affecting adult men worldwide, requires accurate staging and early detection of recurrent disease to guide treatment decisions and improve oncological outcomes. 18F-PSMA-1007 PET/CT is a novel radiotracer with favorable imaging characteristics suggesting an important role within the Prostate Cancer management landscape. Methods: The Arksey and O’Malley Framework was used to guide this review. PubMed/MEDLINE, EMBASE, EBSCO, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were used, and relevant titles were screened for eligibility. Results: 404 database results were returned; 343 titles were excluded due to irrelevance and duplicates. A total of 61 papers were included for title and abstract review with a subsequent 26 excluded due to not meeting the inclusion criteria. A total of 35 papers proceeded to full-text review and 35 papers were included in this review. Evidence was grouped under three major themes: (1) The role of 18F-PSMA-1007 PET/CT in Initial staging; (2) The role of 18F-PSMA-1007 PET/CT in the detection of recurrent Prostate Cancer and (3) The Role of 18F-PSMA-1007 PET/CT in Salvage Therapy. The findings suggest 18F-PSMA-1007 PET/CT has superior diagnostic accuracy and sensitivity for the initial staging of prostate cancer compared with conventional imaging and other commonly used radiotracers. Strengths included the detection of pelvic and locoregional disease. Limitations included poor specificity for the detection of bone lesions, inconsistent urinary excretion patterns, and high inter-reader variability. Conclusions: 18F-PSMA-1007 PET/CT demonstrates superior diagnostic accuracy and sensitivity in both initial staging and detection of prostate cancer recurrence; however, it is limited by poor specificity for bone lesions and inconsistent urinary excretion patterns. Prospective multicenter trials are required to clearly delineate its role in the initial staging of prostate cancer and detection of recurrent disease. Full article