Search Results (618)

Radiological classification systems are widely used to estimate the difficulty of mandibular third molar extraction, yet their ability to predict patient-centered outcomes remains uncertain. This study investigated whether radiological predictors of surgical difficulty are associated with prolonged operative time and increased postoperative pain, and whether the association between radiological parameters and postoperative pain changes after adjustment for operative time. In this exploratory secondary analysis of a randomized clinical trial, 122 patients undergoing mandibular third molar extraction were evaluated using the Winter and Pell–Gregory classifications and the Pederson difficulty index. Surgical duration was recorded, and postoperative pain was assessed during the early postoperative period using a numeric rating scale. Multivariable regression analyses were applied to identify independent predictors of operative time and postoperative pain. Horizontal and mesioangular impactions were associated with significantly longer operative times. Surgical duration was independently associated with higher postoperative pain (β = 0.03 per minute; R² = 0.22). Importantly, radiological parameters were no longer significant after adjustment for operative time. These findings indicate that the association between radiological complexity and postoperative pain is not independent of operative time and should be interpreted as reflecting shared variance between these factors rather than a direct relationship. Full article

Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings. Full article

Background/Objectives: Early-phase clinical trials (EPCTs) focus on safety and preliminary efficacy, often assessed by RECIST (Response Evaluation Criteria in Solid Tumours) tumour response. Health-related quality of life (HRQoL) is rarely evaluated in EPCTs and may not align with radiological outcomes. Methods: The PEARLER (Patient Experience in Early-Phase Cancer Clinical Trials) study evaluated the demographics, tumour response, HRQoL, and therapy type in two early-phase trial units in Australia between August 2023 and 2024. Patients completed the EORTC QLQ-C30 at baseline and follow-ups. The Global Health Status (GHS) score was selected as the primary HRQoL measure. Tumour response was assessed using RECIST 1.1. Spearman correlation and Kruskal–Wallis testing assessed the associations between RECIST, cross-sectional GHS change (ΔGHS; follow-up minus baseline), and therapy types. Multilevel models were used to evaluate longitudinal GHS values per RECIST category. Results: Of 122 patients recruited to the PEARLER study, 74 patients had paired RECIST and HRQoL data (complete response (CR) n = 0; partial response (PR) n = 15; stable disease (SD) n = 39; progressive disease (PD) n = 20). The median change in GHS was zero across RECIST groups, with broad individual variability. Notably, 18 of 54 patients (33.3%) with stable or responding disease experienced HRQoL decline. Meanwhile, 10 of 20 (50%) patients with PD experienced stable or improving HRQoL. The best RECIST response and ΔGHS showed a weak but statistically significant negative relationship (Spearman ρ = −0.28, p = 0.017), with the Kruskal–Wallis test demonstrating χ² = 6.20 (p = 0.045), indicating modest group differences driven by the deterioration in PD patients. The multilevel model demonstrated a lower GHS in patients with PD, with no statistically significant interaction of GHS change over time with the RECIST response (p = 0.226). Conclusions: HRQoL change is largely independent of radiologic tumour response and therapy type in EPCT participants. Patients experienced a HRQoL decline despite tumour response. Incorporating patient-reported outcomes alongside RECIST and safety outcomes is important to fully capture the impact of investigational therapies and guide patient-centred trial designs. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is increasingly observed in patients undergoing supracricoid laryngeal surgery; however, the impact of postoperative anatomical changes on sleep-disordered breathing remains insufficiently characterized. This pilot study aimed to assess the incidence and severity of OSA after Open Partial Horizontal Laryngectomy type II (OPHL II) and to evaluate correlations between polysomnographic parameters and radiologic measurements of the neolarynx. Methods: A prospective observational cohort study was conducted on ten patients who underwent OPHL II between 2019 and 2024 and were evaluated at least one year postoperatively. The sample size was determined using a conservative estimate appropriate for a pilot prospective study, which required a long postoperative follow-up period of at least one year. All patients completed Stop-Bang, Berlin, and Epworth questionnaires and underwent overnight polysomnography. Cervical CT scans were used to measure airway length to the vocal cords (ALVC), supralaryngeal tract horizontal (SVTH) and vertical (SVTV) segments, and the base-of-tongue–to–cervical-body distance (BTCB). Results: OSA was detected in all patients: 40% mild, 30% moderate, and 30% severe. Mean AHI was 25.5 ± 18.9 events/h, and OSA severity strongly correlated with AHI (rho = 0.94; p < 0.0001). Among radiologic parameters, SVTV showed a positive correlation with OSA severity (rho = 0.82; p = 0.0035), while BTCB demonstrated a significant negative correlation (rho = −0.71; p = 0.0207). No significant associations were found for ALVC or SVTH. Conclusions: Supracricoid laryngectomy produces anatomical changes that predispose patients to OSA. Radiologic metrics—particularly SVTV and BTCB—appear to be meaningful predictors of OSA severity. A multidisciplinary approach is essential for early diagnosis and management. Due to the small number of patients enrolled larger multicenter studies are needed to confirm these findings and define radiologic criteria associated with postoperative OSA. Full article

Background: The prognostic assessment of patients with spinal metastases is primarily based on clinical and radiological parameters. Biological tumor characteristics such as the proliferation marker Ki-67 have prognostic relevance in various metastatic settings. This study aimed to evaluate the prognostic impact of the Ki-67 proliferation index on survival outcomes in patients undergoing surgery for spinal metastases. Methods: We included 166 patients who underwent surgical treatment for spinal metastases at our university clinic between 2015 and 2024. Clinical, functional, tumor-related, and perioperative variables were collected. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory ability of Ki-67, and comparisons were made between patient groups according to Ki-67 expression (≤20% vs. >20%). Results: Based on ROC analysis, Ki-67 demonstrated a moderate but significant predictive ability for 1-year mortality (area under the curve [AUC]: 0.69, p = 0.001). Patients with a Ki-67 index of >20% showed a significantly shorter overall survival than those with a lower Ki-67 index of ≤20% (median overall survival: 5.0 vs. 14.5 months, p < 0.001). One-year mortality was significantly higher in the high Ki-67 group (78.9% vs. 41.8%, p = 0.001). High Ki-67 expression was associated with more aggressive tumor characteristics but was not associated with increased perioperative morbidity. Conclusions: The Ki-67 proliferation index is a significant prognostic biomarker in surgically treated patients with spinal metastases. A Ki-67 index threshold of 20% identifies patients at increased risk of early mortality and significantly reduced overall survival. Full article

Background: Parathyroid lipoadenoma, oncocytic parathyroid adenoma, and water-clear cell parathyroid adenoma (WCCA) are exceptionally rare subtypes of parathyroid adenoma, whose real clinical impact remains unclear. Methods: We performed a literature review and comparison of these uncommon subtypes of parathyroid adenoma, as these lesions may be associated with distinct clinical, pathological and radiological phenotypes. Results: The three groups were comparable in terms of age and gender, mainly affecting middle-aged women. As for the biochemical findings, although PTH level did not show statistically significant differences among the three adenomas, in the two-tail comparison between WCCAs and lipoadenomas, there was a trend towards higher PTH values (p = 0.058). However, serum calcium levels differed significantly, with higher levels in WCCAs than in lipoadenomas (12.1 vs. 11.3 mg/dL; p = 0.002). From a preoperative point of view, ultrasound positivity was significantly higher in WCCAs than in lipoadenomas and oncocytic adenomas (97% vs. 50% vs. 55.3%, p < 0.001), compared to scintigraphy positivity, which was comparable between subtypes and relatively suboptimal (66.7% vs. 64.3% vs. 61.3%; p = 0.825); WCCAs also had an overall more voluminous morphological phenotype. Conclusions: This review, although limited by its reliance primarily on case reports and small case series, confirms that lipoadenoma, oxyphilic adenoma, and WCCAs are rare but clinically relevant subtypes of parathyroid adenoma. These entities may be associated with atypical presentations of primary hyperparathyroidism (including difficult preoperative localization and clinicopathological features raising suspicion of malignancy) and should be recognized as a potential source of diagnostic difficulty. A better understanding of these rare subtypes may improve clinicopathological interpretation, increase awareness of potential diagnostic pitfalls and support a more personalized diagnostic and surgical approach in the future. Full article

Pure mediastinal yolk sac tumor is an uncommon and aggressive malignant germ cell neoplasm that presents considerable diagnostic difficulties owing to its pronounced clinical and morphological variability. Mediastinal yolk sac tumors, in contrast to their gonadal equivalents, typically occur at later stages, are typically associated with mixed germ cell components, and have a diverse array of histologic patterns that may resemble both germ cell and somatic malignancies. Accurate identification of these types of cancer is essential since diagnostic misclassification may significantly impact treatment and prognosis. This review provides a comprehensive overview of the morphologic spectrum of mediastinal yolk sac tumor, with emphasis on both classic and variant histologic patterns, including reticular, solid, glandular, papillary, hepatoid, and other less common growth forms. The immunohistochemical correlations of these patterns and their role in resolving diagnostic dilemmas are discussed, along with key differential diagnoses encountered in small mediastinal biopsy specimens. Particular attention is given to the limitations of limited tissue sampling, the impact of post-chemotherapy morphologic changes, and the potential for misinterpretation in this challenging anatomic site. By integrating morphologic features with clinical, radiologic, and laboratory findings, this review aims to enhance diagnostic accuracy and improve recognition of mediastinal yolk sac tumor across its diverse presentations. Full article

Background: Precise staging of prostate cancer is vital for treatment planning and prognosis. While [⁶⁸Ga]Ga-PSMA-11 PET-CT has demonstrated high diagnostic accuracy in detecting metastatic disease, the interpretation of indeterminate or potentially benign PSMA-avid bone lesions remains a clinical challenge in routine practice. Methods: We conducted a retrospective single-centre study involving 214 patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET-CT between January 2021 and January 2024. Patients with prior known bone metastases or alternative PSMA radiotracers were excluded. Only those with follow-up imaging were included for diagnostic accuracy analysis. Follow-up modalities included PSMA PET-CT, CT, MRI, and bone scintigraphy. Final classification (metastatic or benign) was based on radiological and clinical assessment. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using follow-up imaging as the reference standard. Lesions classified as indeterminate were analysed separately and excluded from diagnostic performance calculations. Results: Of the 214 included patients, 142 had follow-up imaging. Among 80 patients with bone lesions initially reported as metastatic, 74 (92.5%) were confirmed. Among 28 patients initially reported as having benign bone lesions, 26 (92.9%) remained benign on follow-up. Thirty-four patients with indeterminate lesions were reviewed; four were ultimately metastatic. Excluding indeterminate cases, sensitivity, specificity, PPV, and NPV were 97.4%, 86.7%, 94.9%, and 92.9%, respectively. Diagnostic discordance was primarily associated with benign uptake in the ribs, iliac bones, pubic rami and degenerative changes. Conclusions: [⁶⁸Ga]Ga-PSMA-11 PET-CT shows excellent sensitivity and positive predictive value for detecting metastatic bone disease in prostate cancer. However, benign lesions may also exhibit uptake, emphasising the importance of integrating imaging results with PSA levels, Gleason scores, and TNM staging. Prospective studies are needed to validate these findings and assess their impact on long-term outcomes. Full article

Background/Objectives: AI-based tools for chest radiograph interpretation are increasingly used as decision-support systems, yet their performance must be validated in local clinical environments before deployment. This study evaluated the diagnostic performance of qXR (Qure.ai, v3.2) for detecting pulmonary nodules, cardiomegaly, and pleural effusion in adult patients at Hospital Clínica Bíblica, San José, Costa Rica. Methods: Three radiologists independently interpreted 225 chest radiographs, providing the reference standard. qXR outputs were compared against radiologist assessments for each finding. The sensitivity, specificity, Cohen’s kappa, and area under the ROC curve (AUC) were calculated. Due to the convenience-stratified sampling design, predictive values were not used for clinical interpretation. Results: For pulmonary nodules, qXR achieved a sensitivity of 0.71, specificity of 0.90, Cohen’s kappa of 0.51, and AUC of 0.80. For pleural effusion, sensitivity and specificity were both 0.86, with a kappa of 0.63 and AUC of 0.86. Cardiomegaly showed the lowest agreement, with a sensitivity of 0.64, specificity of 0.91, kappa of 0.57, and AUC of 0.77. Conclusions: qXR demonstrated moderate diagnostic agreement with radiologist assessments for pulmonary nodules and pleural effusion, and lower agreement for cardiomegaly under local imaging conditions. These results reflect technical concordance between the AI system and individual radiologists and do not constitute evidence of clinical utility or real-world impact. Context-specific validation is essential prior to integrating AI tools into routine radiological workflows. Full article

Background/Objectives: Radiological assessment has become indispensable for modern clinical decision-making. Image quality plays a critical role in the reliability of radiological interpretation. Unlike most previous studies, this study investigated the effect of monitor type on diagnostic accuracy and ease of diagnosis under physical conditions outside the radiology unit. Methods: Three image sets were prepared for the study, consisting of emergency radiological images, each containing 50 computed tomography, magnetic resonance imaging, and digital radiography images. The image sets were examined by five emergency specialists, who were blinded to each other’s work, under emergency service conditions on a standard monitor (SM), medical monitor (MM), and advanced monitor (AM). The accuracy and ease of diagnosis were analyzed statistically according to the type of monitor used. Results: Overall diagnostic accuracy rates were 98.7% for SM, 100% for AM, and 100% for MM. Cochran’s Q test demonstrated a statistically significant difference between monitor types (p = 0.002), with significant pairwise differences for SM–AM and SM–MM comparisons. The absolute risk difference between SM and AM/MM was 1.3%, corresponding to a relative risk of 1.013 and a number needed to benefit (NNB) of 77. Ease of diagnosis scores increased progressively across monitor types (SM: 7.6 [IQR 7–8], AM: 9.4 [IQR 9–9.8], MM: 9.8 [IQR 9.6–10]; p < 0.001), with a large overall effect size (Kendall’s W = 0.81). Multilevel modeling confirmed that these associations persisted after adjustment for clustering effects. Conclusions: In situations where medical monitors cannot be used due to cost and operational constraints, opting for advanced monitors instead of standard monitors may modestly improve diagnostic accuracy while substantially enhancing perceived ease of diagnosis. Full article

Background: The generation of synthetic CT images from MRI scans represents a crucial step toward enabling MRI-only clinical workflows and supporting multi-modal integration in medical imaging, particularly in radiotherapy planning. Despite significant advancements in deep learning models, many current methods still struggle to reconstruct high-density structures, especially bone, and exhibit limited accuracy in density values. This shortcoming is largely attributed to the passage of excessive or noisy features through skip connections in the traditional U-Net architecture, which degrade the quality of information transmitted to the decoder, negatively impacting the clarity of anatomical boundaries and the pixel-wise accuracy of the resulting synthetic image. Methods: In this work, we propose an enhanced 3D U-Net architecture in which the Convolutional Block Attention Module (CBAM) is systematically integrated within each skip connection. The CBAM sequentially applies channel and spatial attention to adaptively reweight encoder feature maps before fusion with the decoder, thereby emphasizing anatomically relevant structures while suppressing irrelevant feature propagation. The model was trained and evaluated on the SynthRAD2023 (Task 1—Brain) MRI–CT dataset. To rigorously assess the contribution of the attention mechanism, a dedicated ablation study was conducted comparing three variants: 3D U-Net with Squeeze-and-Excitation (SE), Coordinate Attention (CA), and the proposed CBAM module. Performance was evaluated using Mean Absolute Error (MAE), Root Mean Square Error (RMSE), Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Normalized Cross-Correlation (NCC). Results: The ablation study demonstrated that the CBAM-enhanced model consistently outperformed both SE- and CA-based variants across all quantitative metrics. Specifically, the proposed method achieved an MAE of $38.2\pm 5.4$ HU and an RMSE of $51.0\pm 12.0$ HU, representing the lowest reconstruction errors among the evaluated models. In addition, it obtained a PSNR of $29.45\pm 2.10$ dB, SSIM of $0.940\pm 0.031$, and NCC of $0.967\pm 0.015$, indicating superior structural preservation and strong voxel-wise correspondence between synthesized and reference CT volumes. These results confirm that the sequential integration of channel and spatial attention provides a statistically and practically meaningful improvement for high-fidelity MRI-to-CT synthesis. Conclusions: Generating high-resolution brain CT images from brain MRI scans using a 3D U-Net network enhanced with a CBAM module can contribute to supporting the clinical workflow by providing additional diagnostic data without the need for extra radiological examinations, thereby enhancing diagnostic efficiency and reducing radiation exposure. This technique helps reduce patient exposure to radiation and improves accessibility in resource-limited settings. Furthermore, this method is valuable for retrospective studies, surgical planning, and image-guided therapy, where complete multi-modal data may not always be available. Full article

This paper describes a new methodology implemented in the ESTE decision support system for evaluating the source term resulting from a nuclear weapon detonation. The methodology is based on a model of a stabilized radioactive mushroom cloud, parameterized as the source term for a Lagrangian particle dispersion model. It includes radionuclide composition, spatial distribution of aerosol and gaseous particles, and particle size distribution. This method is designed for rapid assessment of radiological impacts primarily at medium- and long-range distances, for example, in neighboring countries. The parametrization has been calibrated and adjusted using data from historical nuclear tests, and its performance is evaluated in terms of impacted area, range, and spatial overlap of fallout regions. A comparison is presented between ESTE calculations and field measurements obtained after the British nuclear tests conducted in the 1950s at the Maralinga Range (Australia), using historical ERA5 meteorological reanalyses from ECMWF. Full article

Background: Radiologically isolated syndrome (RIS) is defined by MRI findings that are suggestive of multiple sclerosis (MS) in the absence of prior clinical demyelinating events. We aimed to compare the health-related quality of life (HRQoL) between RIS and relapsing–remitting MS (RRMS) after adjusting for fatigue, cognition, and psychological distress, and to contextualize generic HRQoL, relative to healthy controls. Methods: In this cross-sectional analysis of the baseline data, 30 RIS, 29 RRMS, and 30 healthy controls were analyzed. MS-specific HRQoL (patients only) was assessed with the Functional Assessment of Multiple Sclerosis (FAMS), and generic HRQoL (all participants) was assessed with the EuroQol-5D (EQ-5D) visual analogue scale and utility index. Multi-variable linear regression models with robust (HC3) standard errors were used, adjusting for demographics, fatigue impact, cognitive performance, and psychological distress. Results: The FAMS totals were similar in RIS vs. RRMS (median 167.5 vs. 164.0; p = 0.694) and remained non-different after adjustment (β= −2.37, 95% CI −10.18 to 5.44; p = 0.544). EQ-5D outcomes showed an unadjusted gradient across groups, but adjusted differences relative to RIS were not statistically significant. Greater fatigue impact was associated with poorer HRQoL across all models (all p < 0.001). Psychological distress was associated with lower FAMS (β = −14.53; p < 0.001) but not with EQ-5D outcomes. Conclusions: HRQoL in RIS was comparable to RRMS, and fatigue impact was the most consistent correlate of poorer HRQoL. Full article

Background: Duloxetine, a serotonin–norepinephrine reuptake inhibitor, is widely used both preoperatively and postoperatively in patients with neuropathic low back pain. This study aimed to determine the impact of duloxetine administration on posterolateral spinal fusion in rats and to evaluate the dose-dependent relationship of this effect. Methods: A pre-established rat model for posterolateral spinal fusion was employed, and four equal groups were formed, each undergoing posterolateral spinal fusion surgery. Except for the control group, the other groups received duloxetine postoperatively starting on day 1 at doses of 30 mg/kg/day, 60 mg/kg/day, and 120 mg/kg/day for six weeks. All rats were sacrificed after six weeks. Fusion status was assessed using manual palpation, radiological examination with plain radiography, and histopathological evaluation. Results: No significant differences were observed between groups in manual palpation scoring or radiological scoring. Histopathological evaluations of new bone formation also showed no significant differences between groups. The number of inflammatory cells was found to be higher in the control group compared to the low- and moderate-dose duloxetine groups (p = 0.012). Neovascularization scores were slightly higher in the control group compared to the duloxetine-treated groups (p = 0.048). Conclusions: In this experimental rat model of posterolateral spinal fusion, duloxetine administration was associated with reduced inflammatory cell infiltration and mildly decreased neovascularization on histopathological evaluation. However, these histological differences did not translate into measurable differences in fusion outcomes, as assessed by manual palpation, radiological scoring, or new bone formation. Overall, postoperative duloxetine treatment did not demonstrate a detrimental effect on spinal fusion success, suggesting that its use for neuropathic pain management may be biologically applicable with respect to fusion healing in this animal model. Full article

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic nerve (ON), Vidian nerve (VN), and maxillary nerve (MN) within a Greek adult population. Methods: A retrospective analysis of 253 adult skull base computed tomography (CT) scans was performed. The degree and direction of SSP were classified according to established radiological criteria. Anterior, lateral, and posterior extensions were evaluated. The course of adjacent neurovascular structures was categorized as typical, protruding, or dehiscent. Associations between pneumatization types and neurovascular variants were analyzed. Results: The sellar complete type was the predominant SS pattern (63.2%), followed by sellar incomplete (27.7%) and presellar (8.7%) types; agenesis was rare (0.4%). Posterior (63.6%) and lateral (46.6%) extensions were most common. Lateral and posterior pneumatization significantly correlated with protrusion and/or dehiscence of adjacent neurovascular structures, particularly the ICA, ON, and VN. LW extension was strongly associated with ON protrusion (96%), while PP and full-lateral extensions correlated with VN protrusion (56.1% and 79.9%, respectively). No significant sex- or side-related differences were identified. Conclusions: SSP demonstrates extensive morphological variability that significantly affects the anatomical course and osseous coverage of neighboring neurovascular structures. Comprehensive preoperative CT evaluation of SS anatomy is essential for planning endoscopic transsphenoidal and extended skull base procedures to minimize the risk of neurovascular injury. Full article