Search Results (935)

Background: The development of advanced genomic sequencing techniques now makes it possible to identify novel biomarkers and guide the design of targeted therapeutic strategies. For advanced squamous non-small cell lung cancer (NSCLC), V-Raf murine sarcoma viral oncogene homolog B1 (BRAF) fusions have not been evaluated as a therapeutic target. However, agents that block the pathway activated by these fusions have shown efficacy in other solid tumors, such as melanoma, astrocytoma, acinar carcinoma of the pancreas, and papillary thyroid tumors. Case Report: Here, we present the case of a patient with locally advanced squamous NSCLC and minimal smoking history who was found to harbor a TMEM178B::BRAF fusion. Following curative-intent chemoradiotherapy (CRT) and subsequent maintenance immunotherapy, the patient achieved a complete radiological response at 12 months, accompanied by a marked improvement in both quality of life and overall clinical status. Conclusions: The findings in this patient underscore the importance of extending molecular genetic studies to patients with squamous histology who lack toxic habits or known risk factors. Gene alterations such as BRAF rearrangements may not only predict the response to immunotherapy-based treatments but also represent a promising avenue for the development of new therapeutic strategies. Full article

Background: Nasopharyngeal carcinoma diagnosis requires endoscopic biopsy, but intraoperative hemorrhage frequently impairs visualization and compromises tissue sampling quality. This prospective case series evaluated topical tranexamic acid (TXA) as a hemostatic adjunct to improve biopsy conditions in suspected nasopharyngeal malignancy. Methods: Adults (≥18 years) with clinically/radiologically suspected nasopharyngeal tumors underwent pre-biopsy laboratory screening and exclusion of thromboembolic risk factors. After topical lidocaine anesthesia, a TXA-soaked cotton pledget was applied to the lesion for 10 min prior to forceps biopsy using 0° 4 mm endoscopy. Bleeding severity was graded pragmatically (minimal: ≤3 gauze pledgets; moderate: >3 or cauterization). Comparative analyses excluded rare diagnoses (n = 1). Results: Of 40 enrolled patients, 34 underwent biopsy (mean age 58.4 ± 12.3 years). All 34 biopsies (100%) yielded conclusive histopathological diagnoses. Adequate hemostasis was achieved in 97.1% (33/34), with minimal bleeding in 76.5% and moderate/massive in 23.5%. Non-keratinizing squamous cell carcinoma (44.1%) showed higher moderate bleeding rates than other diagnoses (Fisher’s exact p = 0.00035). Mean hospitalization was 1.79 ± 1.92 days, uniform across categories. No TXA-related adverse events occurred. Conclusions: Topical TXA provided safe, effective hemostasis during nasopharyngeal biopsy across diverse pathologies, achieving 100% diagnostic adequacy and short hospital stays. Controlled trials comparing TXA versus standard hemostatic techniques are warranted. 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

Radiological departments face challenges in efficiency and diagnostic consistency. The interpretation of radiographs remains highly variable between practitioners, which creates potential disparities in patient care. This study explores how artificial intelligence (AI), specifically transfer learning techniques, can automate parts of the radiological workflow to improve service quality and efficiency. Transfer learning methods were applied to various convolutional neural network (CNN) architectures and compared to classify medical images across different modalities, i.e., X-rays, ultrasound, magnetic resonance imaging (MRI), and angiography, through a two-component model: medical image modality prediction and anatomical region prediction. Several publicly available datasets were combined to create a representative dataset to evaluate residual networks (ResNet), dense networks (DenseNet), efficient networks (EfficientNet), and the Swin Transformer (Swin-T). The models were evaluated through accuracy, precision, recall, and F1-score metrics with macro-averaging to account for class imbalance. The results demonstrate that lightweight transfer learning methods effectively classify medical imagery, with an accuracy of 97.21% on test data for the combined transfer learning pipeline. EfficientNet-B4 demonstrated the best performance on both components of the proposed pipeline and achieved a 99.6% accuracy for modality prediction and 99.21% accuracy for anatomical region prediction on unseen test data. This approach offers the potential for streamlined radiological workflows while maintaining diagnostic quality. The strong model performance across diverse modalities and anatomical regions indicates robust generalisability for practical implementation in clinical settings. Full article

Background: Posterior approaches to intramedullary spinal cord tumors traditionally rely on bilateral laminotomy or laminoplasty to ensure adequate midline exposure and contralateral dissection. Unilateral approaches are seldom applied in this context, due to concerns regarding insufficient visualization and limited working angles across the midline. Objective: To describe a modified hemilaminectomy technique designed to achieve safe midline myelotomy and bilateral tumor dissection through a unilateral corridor, preserving the structural and clinical benefits of minimally invasive posterior access. Methods: Fourteen patients with intramedullary spinal cord tumors underwent resection via a refined hemilaminectomy technique, which incorporated systematic thinning of the spinous process and strategic dural suspension. Pre- and postoperative neurological status was assessed using the modified McCormick scale. Surgical parameters, postoperative outcomes, and radiological follow-up were retrospectively collected. Results: Gross total resection was achieved in 13 of 14 patients (92.9%), with no new permanent neurological deficits. The mean surgical duration was 194.8 ± 55.9 min, and mean hemoglobin decrease was 1.47 ± 0.94 g/dL. Early postoperative improvement in McCormick grade was observed in 50% of cases, with statistically significant overall functional recovery (p = 0.013). No cases of postoperative cord tethering were identified on follow-up magnetic resonance imaging. The approach was technically reproducible and ergonomically favorable, with a shallow learning curve in surgeons experienced with conventional hemilaminectomy. Conclusions: The modified hemilaminectomy technique enables effective bilateral exposure and safe midline myelotomy through a unilateral approach, achieving high resection rates with minimal morbidity. It represents a feasible and reproducible alternative to bilateral approaches and warrants prospective validation. Full article

Objectives: In the perspective of an increasingly widespread application of precision medicine in rheumatoid arthritis (RA), this study aimed to compare efficacy and safety of ultrasound-guided synovial biopsy (US-SB) performed in an experienced rheumatology and community hospital setting. Methods: A post hoc analysis of R4RA, STRAP and STRAP-EU trials was performed, comparing US-SB performed in a radiology department of a community hospital without experience in RA (n = 14), versus a rheumatology academic centre with a high expertise in RA management and US-SB (n = 16). Suitability of specimens for histological and transcriptomic analysis (tissue and RNA quality) was analyzed as the main outcome. Results: Demographic and clinical features of the two patients’ groups were similar, except of disease duration (p < 0.05). No differences were recorded regarding site and ultrasound of the biopsied joint. Suitability for histological (% of gradable tissue) and transcriptomic analysis (RIN >3) was similar in the two cohorts (both 85.7% vs. 87.5%, p = 0.88). Proportion of gradable biopsies in total (59.2% vs. 59.5%, p = 0.96) and for each patient (52% vs. 56.15%, p = 0.77), were similar in both cohorts. Adverse events were rare (two in community hospital cohort, one in rheumatology cohort, p = 0.54), none considered severe. Seven patients in the community hospital experienced mild or severe pain, only two referred the same in the rheumatology cohort (p = 0.04). Conclusions: US-SB can be safely and effectively performed in a community hospital without experience in RA. A larger diffusion of this technique could allow to pursuit a tailored approach also in ordinary rheumatology outpatient clinics. Full article

Background: e-Lung (Brainomix) is an artificial intelligence (AI)-driven software that is based on multi-class convolutional neural network (CNN) techniques. The aim of this research was to demonstrate the feasibility of e-Lung to evaluate progression in lung volume reduction in patients with interstitial lung disease (ILD) undergoing lung transplant assessments. Methods: This was a single-center retrospective cohort study of consecutive patients with ILD who received lung transplants between June 2021 and November 2024. Patients who underwent serial prospective conventional evaluations using lung function testing (LFT) and conventional radiological assessments as well as retrospective lung volume measurements using e-Lung were included in this study. Results: An analysis of 20 consecutive patients who met strict inclusion criteria and underwent an additional e-Lung assessment revealed that both the serial physiological actual total lung capacity (aTLC) measurements and e-Lung-derived lung volume measurements were able to provide recipient lung size estimations and detect serial declines in lung volume. A poorer DLCO (2.61 ± 0.77 vs. 3.87 ± 1.59 mmol/min/kPa, p = 0.044) at the time of wait-listing was associated with a significant lung volume reduction. Conclusions: e-Lung may serve as an additional upscale tool for the rapid and objective quantitative evaluation of the actual lung volume and the detection of the extent of parenchymal shrinking in patients with advanced ILD awaiting lung transplantation. Full article

Non-operating room anesthesia (NORA) has emerged as one of the fastest-growing domains of modern anesthetic practice. Increasing procedural complexity and an aging, comorbid patient population demand analgesic strategies that enhance safety, comfort, and procedural success while minimizing physiological disturbance. Although systemic opioids and sedatives remain commonly used in NORA settings, their dose-dependent adverse effects may compromise patient safety and delay recovery, particularly in environments with limited postprocedural monitoring. Ultrasound-guided fascial plane blocks (FPBs) have therefore gained prominence as key components of opioid-sparing and opioid-free anesthetic strategies. By providing targeted regional analgesia with preserved hemodynamic stability, FPBs reduce systemic analgesic requirements and opioid-related side effects while improving patient comfort. This review summarizes the anatomical basis, proposed mechanisms of action, and current clinical evidence supporting the use of thoracic and abdominal fascial plane blocks in NORA settings, with particular emphasis on interventional cardiology and interventional radiology procedures. The expanding role of FPBs suggests that these techniques may become integral elements of standard analgesic protocols in contemporary non-operating room anesthesia practice. Full article

Background: Recent advances in multimodal therapies have increased the potential for resectability of borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). We herein describe the conservative resection strategy adopted at our institution and the oncological outcomes of patients with PDAC and arterial involvement. Methods: This retrospective single-centre study included patients diagnosed with PDAC and radiologic evidence of arterial involvement who underwent surgical exploration between January 2014 and June 2024. All patients received induction chemotherapy (±radiotherapy). Survival outcomes were analyzed using the Kaplan–Meier and Cox proportional hazards models. Logistic regression analyses were used to identify predictors of resectability and recurrence. Results: A total of 76 patients were included: 59 underwent pancreatic resection with arterial divestment (AD) in case of persistent arterial involvement and 17 were deemed unresectable at laparotomy. Neoadjuvant folfirinox was significantly associated with increased odds of resection (HR = 3.23, 95% CI: 1.59–9.90, p = 0.040). Median overall survival from diagnosis was 33 months (29–39) in resected patients and 26 months (16–29) in non-resected patients (p = 0.0176). Surgical resection and Ca 19,9 normalization after induction therapy were associated with reduced mortality risk (HR = 0.38, 95% CI: 0.19–0.75, p = 0.005 and HR = 0.56, 95% CI: 0.35–0.88, p = 0.014, respectively). Conclusions: Despite a limited sample size and retrospective nature, these findings highlight the value of multimodal strategies in managing PDAC with arterial involvement. AD represents a valuable technique associated with acceptable outcomes in selected patients. Future interventional prospective studies are needed to optimize patient selection and validate the prognostic role of extended surgical procedures. Full article

Background/Objectives: To systematically review and critically appraise AI methods for RECIST-based radiologic treatment response assessment in solid tumors, comparing image-derived and report-derived approaches and summarizing their performance, agreement with reference standards, and validation quality. Methods: This systematic review followed PRISMA guidelines. We searched Embase, MEDLINE, Web of Science, Scopus, and the Cochrane Library on 6 December 2025. We included English-language original studies (2015–2025) in solid tumors where AI directly assigned RECIST response categories and was validated against a reference standard; studies without RECIST-based response endpoints or non–solid tumor populations were excluded. We distinguished image-based techniques that assign RECIST categories from direct analysis of imaging data from report-based techniques that infer RECIST categories from radiology reports using natural language processing. Results: Evidence remains sparse; we identified four eligible studies (two image-based and two report-based). DeepSeek-V3-0324 and GatorTron, both report-based approaches, achieved high accuracy (96.5% and 89%, respectively) in treatment response evaluation, with DeepSeek demonstrating higher expert agreement (κ 0.85–0.90). The nnU-Net and 3D U-Net pipelines, both image-based, showed high segmentation performance (DSC 0.85, VS 0.89) and treatment response classification accuracy of 0.77 for R1, with moderate agreement with the manual reference (κ = 0.60); nnU-Net also achieved moderate to almost perfect agreement (Cohen’s κ 0.67–0.81) in RECIST 1.1 measurements. Conclusions: AI-based RECIST-oriented response assessment is feasible and potentially beneficial for standardization, efficiency, and scalability, but current evidence is limited and heterogeneous, requiring larger multi-center studies with rigorous external validation before clinical adoption. Key limitations include data source variability, reference standard inconsistencies, and lack of robust external validation. Full article

Background/Objectives: Intraoperative navigation is predominantly utilized in thoracolumbar spine surgeries; however, its application in cervical procedures has swiftly increased in prevalence. Despite the growing prevalence of these systems, there is a paucity of scholarly publications that address the historical development, delineate the fields of application, and discuss the benefits and drawbacks of this growingly prevalent technology in cervical spine surgery. Our aim was to provide a succinct summary of the history of cervical spine navigation systems, zones of implementation, associated advantages and disadvantages, and recommendations for future improvements. Methods: We conducted an extensive literature review focusing on the evolution and application of intraoperative navigation technology in cervical spine surgery. The research sources included peer-reviewed journals indexed in PubMed, data from clinical trials, and case studies that examined various navigation systems, with particular emphasis on the latest intraoperative navigation technologies. Results: In addition to facilitating minimally invasive approaches in cervical spine surgery, intraoperative navigation systems have been successfully employed in various decompression procedures, corpectomies, and tumor excisions. The accurate and safe placement of implants has been significantly enhanced in all cervical spine fixation techniques, particularly in those requiring high precision, such as occipital condyle, odontoid, transarticular, and translaminar screw fixations. However, technical difficulties, increased radiation exposure to patients, and high costs remain significant challenges that must be addressed. Conclusions: Intraoperative navigation systems in cervical spine surgery have demonstrated efficacy across various cervical spine procedures, offering additional advantages in facilitating minimally invasive approaches. However, the technical challenges associated with their use, which impact accuracy, as well as increased radiological exposure and cost, represent significant drawbacks that warrant attention in future research. Full article

Background and Objectives: Uterine arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare but potentially life-threatening vascular anomalies that most commonly develop after pregnancy-related uterine trauma, such as curettage or surgical evacuation. The widespread use of color Doppler ultrasonography has led to increased recognition of these lesions and a shift from hysterectomy toward fertility-preserving, minimally invasive management. This narrative review summarizes current evidence on acquired uterine AVF/AVM after early pregnancy loss, with particular emphasis on diagnostic challenges and contemporary therapeutic approaches, illustrated by representative clinical experience. Materials and Methods: A narrative review of the literature was conducted focusing on the pathophysiology, ultrasound and Doppler diagnostic criteria, interventional radiologic techniques, hysteroscopic management, and fertility outcomes in acquired uterine AVF/AVM. Illustrative clinical insights from anonymized post-abortion cases managed at our institution were incorporated solely to contextualize diagnostic and therapeutic considerations. Results: Color and spectral Doppler ultrasonography emerged as the diagnostic cornerstone, typically demonstrating serpiginous myometrial vessels with high-velocity, low-resistance turbulent flow, allowing for differentiation from retained products of conception. Uterine artery embolization showed high efficacy in achieving hemorrhage control, while hysteroscopic coagulation or resection represented an effective complementary or, in selected focal lesions, definitive treatment. Clinical experience highlighted that AVF-related vascularity may be evident early or may evolve over time, underscoring the importance of repeat Doppler evaluation in patients with persistent or recurrent bleeding. Conclusions: Acquired uterine AVF should be considered in women presenting with ongoing or recurrent uterine bleeding following aspiration abortion or curettage, even when initial Doppler findings are inconclusive. Individualized, minimally invasive strategies—often combining uterine artery embolization and hysteroscopic techniques—offer effective, uterus-preserving alternatives to hysterectomy. Full article

Hallux fractures, particularly those involving the proximal phalanx, can lead to significant functional impairments if not promptly managed. This report introduces a novel, minimally invasive technique for hallux fracture fixation using hypodermic needles. This technique is specifically designed for resource-limited settings such as disasters or emergencies. A 30-year-old female sustained an open proximal phalanx fracture of the left hallux with interphalangeal joint dislocation following a motor vehicle accident. Under local anesthesia in the emergency service settings, fracture reduction and stabilization were achieved using two hypodermic needles. A 21-gauge needle was inserted intramedullary through the medial aspect of the hallux to stabilize the fracture, while an 18-gauge needle was placed distally to secure alignment. Postoperative radiographs confirmed proper alignment, and the needles were removed after four weeks. The patient achieved pain-free ambulation with a full range of motion within six months, with no complications noted. This technique offers a cost-effective, rapid, and practical alternative to traditional methods, eliminating the need for fluoroscopy or specialized surgical tools. It is particularly valuable in emergency and resource-constrained environments, providing favorable clinical and radiological outcomes. This approach demonstrates significant potential for managing hallux fractures in challenging settings and warrants further validation in broader orthopedic practice. Full article

Extrapulmonary tuberculosis (EPTB) is an infectious disease characterized by the invasion of Mycobacterium tuberculosis beyond the lungs. Diagnosis is frequently delayed due to nonspecific clinical presentations that vary by organ system, making diagnostic imaging essential for disease detection, characterization, and treatment monitoring. The objective of this review is to examine and summarize imaging-based approaches for the diagnostic evaluation of EPTB across multiple body systems, including the central nervous system, spine, cardiovascular system, lymphatic system, abdominal and hepatic organs, genitourinary tract, cutaneous and soft tissue, and other rare sites. While computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound are widely used in the evaluation of EPTB, their ability to provide a definitive diagnosis is often limited by nonspecific radiologic findings. Emerging techniques, including perfusion-weighted MRI, contrast-enhanced ultrasound, and machine learning, have been discussed, as they improve lesion characterization and EPTB differentiation. By organizing imaging findings according to affected organ systems, this review highlights both shared diagnostic challenges and site-specific patterns that can inform clinical suspicion. Together, these developments underscore the value of a multimodal, organ-specific imaging approach integrated with the clinical context to improve the recognition and management of EPTB. Full article

Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and increased mortality. When conventional warming strategies fail, intravascular temperature management systems may be employed, although they carry risks inherent to central venous catheters. Case Report: We report the case of a 26-year-old male with 66% total body surface area flame burns and inhalational injury, admitted to the Burns Intensive Care Unit with persistent hypothermia despite standard warming measures. An intravascular temperature management catheter was inserted via the femoral vein and successfully restored normothermia. Due to clinical instability, the catheter remained in situ beyond the recommended duration. During attempted catheter removal, significant resistance was encountered, raising concern for mechanical malfunction. Imaging confirmed catheter entrapment without fracture. Multidisciplinary management involving vascular surgery and interventional radiology enabled successful removal using endovascular snare techniques. A detached balloon fragment was identified and secured with venous stenting. Conclusions: This report describes the first documented case of complicated removal of an intravascular warming catheter due to balloon detachment in burn patients. Physicians using these devices should be aware of this possible complication and be prepared for its management. Full article