Search Results (144)

Background and Objectives: The objective of this research is to make a comparative evaluation of the correlation between the volumetric examination of subcortical cerebral regions and white matter hyperintensities classified according to the Fazekas scoring system. Materials and Methods: A total of 236 cases with cranial MRI studies were retrospectively analyzed. This study included patients aged over 45 years who had white matter hyperintensities and who did not have a prior stroke diagnosis. White matter hyperintensities were evaluated in axial FLAIR images according to Fazekas’s grading scale. Patients with Fazekas 0 and 1 were grouped in group 1 and the patients with Fazekas 2 and 3 were grouped in group 2. MRI data processing and subcortical volumetric analyses were performed using the volBrain MRI brain volumetry system. Results: There were statistically significant differences between groups 1 and 2 in terms of cerebrospinal fluid total brain white and gray matter (p < 0.001), total brain white and gray matter (p = 0.009), total cerebrum (p < 0.001), accumbens (p < 0.001), thalamus (p < 0.001), frontal lobe (p < 0.001), parietal lobe (p < 0.001), and lateral ventricle (p < 0.001) volumes. Conclusions: Our study finds a strong link between white matter hyperintensity burden and brain atrophy. This includes volume reductions in total brain white and gray matter, frontal and parietal lobe atrophy, increased cerebrospinal fluid (CSF), and atrophy in specific brain regions such as the accumbens and thalamus. Full article

Background: Delirium is a common, underdiagnosed neuropsychiatric syndrome in older adults, associated with high mortality and functional decline. Given its multifactorial nature and overlap with frailty, radiological markers may improve risk stratification in the emergency department (ED). Methods: We conducted a retrospective study on a small sample of 30 patients diagnosed with delirium in the emergency department who had recently undergone brain, thoracic, or abdominal CT scans for unrelated clinical indications. Using post-processing software, we analyzed radiological markers, including coronary artery calcifications (to estimate vascular age), cerebral atrophy (via the Global Cortical Atrophy scale), and cachexia (based on abdominal fat and psoas muscle volumetry). Results: Five domains were identified as significant predictors of 12-month mortality in univariate Cox regression: vascular age, delirium etiology, cerebral atrophy, delirium subtype (hyperactive vs. hypoactive), and cachexia. Based on these domains, we developed an exploratory 10-point delirium score. This score demonstrated acceptable diagnostic accuracy for mortality prediction (sensitivity 0.93, specificity 0.73, positive predictive value 0.77, negative predictive value 0.91) in this limited cohort. Conclusions: While preliminary and based on a small, retrospective sample of 30 patients, this multidimensional approach integrating clinical and radiological data may help improve risk stratification in elderly patients with delirium. Radiological phenotyping, particularly in terms of vascular aging and sarcopenia/cachexia, offers objective insights into patient frailty and could inform more personalized treatment pathways from the ED to safe discharge home, pending further validation. Full article

Background: Pancreatic neuroendocrine tumors (PanNETs) are relatively rare neoplasms with heterogeneous behavior, ranging from indolent to aggressive disease. The evolution of nuclear medicine has allowed the development of an efficient and advanced toolkit for the diagnosis and treatment of PanNETs. Case: A 45-year-old woman was diagnosed with a grade 1 PanNET and multiple liver metastases. She underwent distal pancreatectomy with splenectomy, extended liver resection, and radiofrequency ablation (RFA). Surgical planning was guided by [^99mTc]Tc-EDDA/HYNIC-TOC SPECT/CT (single-photon emission computed tomography/computed tomography) and preoperative [^99mTc]Tc-mebrofenin-based functional liver volumetry. Functional liver volumetry based on dynamic [^99mTc]Tc-mebrofenin SPECT/CT facilitated precise surgical planning and reliable assessment of the efficacy of parenchymal modulation, thereby aiding in the prevention of post-hepatectomy liver failure. Liver fibrosis was non-invasively evaluated using two-dimensional shear wave elastography (2D-SWE). Tumor progression was monitored using somatostatin receptor scintigraphy, chromogranin A, and contrast-enhanced CT. Recurrent disease was treated with somatostatin analogues (SSAs) and [¹⁷⁷Lu]Lu-DOTA-TATE peptide receptor radionuclide therapy (PRRT). Despite progression to grade 3 disease (Ki-67 from 1% to 30%), the patient remains alive 53 months post-diagnosis, in complete remission, with an ECOG (Eastern Cooperative Oncology Group) status of 0. Conclusions: Functional imaging played a pivotal role in guiding therapeutic decisions throughout the disease course. This case not only underscores the clinical utility of advanced nuclear imaging but also illustrates the dynamic nature of pancreatic neuroendocrine tumors. The transition from low-grade to high-grade disease highlights the need for further studies on tumor progression mechanisms and the potential role of adjuvant therapies in managing PanNETs. Full article

Background/Objectives: Assessing hippocampal pathology in epilepsy is challenging, and improving diagnostic accuracy can benefit from deep learning image reconstruction, standardized imaging protocols, and advanced post-processing methods. This study compares T2 TSE DRB (Deep Resolve Boost) sequences with standard T2 TSE sequences for hippocampal segmentation and volumetry using FreeSurfer, focusing on how DRB affects image acquisition time without compromising diagnostic accuracy. Methods: FreeSurfer (version 7.4.1) was used to segment hippocampal subregions in 36 subjects (mean age of 39 ± 14 years; 21 males, 15 females) using both T2 TSE DRB and T2 TSE sequences. The segmented volumes were compared with a two-tailed t-test, and pathological volume differences were assessed using z-values based on a 95% confidence interval (−2 < z < 2). Results: Overall hippocampal segment volumes were identical between sequences. However, significant volume differences were noted in the CA1-Body (p = 0.003), CA4-Body (p = 0.002), and whole hippocampal body (p = 0.012) in the right hippocampus. Despite these differences, the low effect sizes suggest DRB sequences are comparable to conventional sequences. Additionally, DRB reduced image acquisition time by 61%. Z-scores identified pathological volume changes between the left and right hippocampus in individual subjects. Conclusions: T2 TSE DRB sequences are non-inferior to conventional T2 TSE sequences for hippocampal segmentation. The DRB method improves efficiency while providing clinically reliable results, and the proposed 95% confidence interval can aid in more objective assessments of hippocampal pathology. Full article

Background/Objectives: Background: COVID-19 pneumonia leads to alveolar collapse and parenchymal infiltration, contributing to lung volume loss and respiratory failure. Objectives: To quantify lung volume loss and recovery in moderate and severe cases, explore mechanisms of respiratory failure, and correlate imaging findings with histopathological changes. Methods: We retrospectively analyzed 43 patients with moderate/severe COVID-19. CT scans from the acute phase and at 3–12 months follow-ups were processed using 3D Slicer. Infiltrated (−650 to −200 HU) and collapsed (−200 to 0 HU) lung regions were quantified and summed to define the affected lung volume. CT severity scores and total affected percentage were compared with lung volume loss. Histopathological analysis of three autopsy cases was used to support imaging findings. Results: Median acute phase lung volume loss was 30.6%. Patients with <25%, 25–50%, and >50% affected lung had median losses of 6.5%, 35.7%, and 39.8%, respectively. Volume loss strongly correlated with affected lung percentage (r = 0.72, p < 0.000001) and moderately with CT severity score (r = 0.52, p < 0.01). Histology confirmed alveolar area reductions over 65% in infiltrated regions. Conclusions: Lung volume loss reflects both imaging severity and histopathological damage, offering insights into the mechanisms of COVID-19 respiratory failure. CT volumetry is a valuable tool for assessing parenchymal injury and monitoring recovery, and 3D Slicer provides an accessible platform for implementing this approach. Full article

This study investigates long-term volume reduction after microsurgical autologous lymphatic vessel transplantation (LVT) in patients with chronic lymphoedema. Lymphoedema is caused by inadequate lymphatic drainage and leads to swelling, pain, and a reduced quality of life. Conservative treatments often show only limited success, which is why surgical procedures such as LVT are increasingly gaining in importance. In a retrospective long-term analysis, patients who underwent LVT between 1988 and 2010 were examined on average 21.7 years after surgery. The examination included pre- and post-operative volume measurements, which were supplemented by modern 3D body scanner analyses and lymphoscintigraphy. The results show a significant volume reduction both in the short term (p < 0.01) and at the follow-up examination (p = 0.04). There was no significant difference between manual volumetry with circumferential measurements and 3D volumetry (p = 0.775). The improvement in lymph transport capacity was considerable (p = 0.078). This study provides valuable insights for the further development of lymphatic surgery. While preferred surgical methods change over time, this study demonstrates that LVT can make a decisive contribution to improving the quality of life of lymphedema patients. Full article

Background: Accurate assessment of brain atrophy is essential in the diagnosis and monitoring of brain aging and neurodegenerative disorders. Radiological methods range from narrative reporting to semi-quantitative visual rating scales (VRSs) and fully automated volumetric software. However, their integration and consistency in clinical practice remain limited. Methods: In this retrospective study, brain MRI images of 43 patients were evaluated. Brain atrophy was assessed by extrapolating findings from narrative radiology reports, three validated VRSs (MTA, Koedam, Pasquier), and Pixyl.Neuro.BV, a commercially available volumetric software platform. Agreement between methods was assessed using intraclass correlation coefficients (ICCs), Cohen’s kappa, Spearman’s correlation, and McNemar tests. Results: Moderate correlation was found between narrative reports and VRSs (ρ = 0.55–0.69), but categorical agreement was limited (kappa = 0.21–0.30). Visual scales underestimated atrophy relative to software (mean scores: VRSs = 0.196; software = 0.279), while reports tended to overestimate. Agreement between VRSs and software was poor (kappa = 0.14–0.33), though MTA showed a significant correlation with hippocampal volume. Agreement between reports and software was lowest for global atrophy. Conclusions: Narrative reports, while common in practice, show low consistency with structured scales and quantitative software, especially in subtle cases. VRSs improve standardization but remain subjective and less sensitive. Integrating structured scales and volumetric tools into clinical workflows may enhance diagnostic accuracy and consistency in dementia imaging. Full article

Background: In recent years, the profunda artery perforator (PAP) flap has gained recognition as a viable technique in autologous breast reconstruction, demonstrating low donor site morbidity and favorable reconstructive outcomes. This study aims to highlight the recent refinements using the PAP flap for breast reconstruction focusing on preoperative volume prediction. Methods: A retrospective study was conducted to evaluate the outcomes of breast reconstruction surgeries using the PAP flap at our institution between May 2018 and December 2022. A total of 114 PAP flaps performed in 96 patients were included. Statistical analysis was performed to analyze flap volume in relation to body mass index (BMI). Surgical details, such as donor site-related complications and patient characteristics, were also collected. Results: BMI was identified as a statistically significant predictor (p < 0.001) for flap weight in the resulting model. The average BMI observed was 23.0, while the mean flap weight was 304.2 g. The predictive model for flap weight was determined as follows: flap weight (g) = (19.252 × BMI) − 143.572. This model underscores the relationship between BMI and flap weight, quantifying the influence of BMI on flap weight prediction. Conclusions: Our study indicates that it is feasible to harvest an adequate volume for breast reconstruction even in patients with a low BMI. To facilitate preoperative prediction of PAP flap volume, we developed an algorithm designed to enhance preoperative planning and estimate the need for supplementary procedures to achieve the desired volume. Full article

Background/Objectives: Radiation therapy can often lead to structural and functional changes in the brain resulting in radiation-induced brain injury. This study investigates the MRI-detectable effects of whole-brain irradiation across all neuroanatomical structures in adult mice, with a specific focus on T2* MRI measurements, to evaluate regions that may be particularly sensitive to iron accumulation. Methods: One year following irradiation or sham treatment, mice were imaged with a 7T MRI to evaluate changes in regional volume and T2* relaxation times across more than 652 neuroanatomical using the DSURQE mouse brain atlas. Results: Statistical analysis identified 301 altered regions with respect to regional volume and 85 regions with respect to T2* relaxation showing significant differences relative to the control group (p < 0.05). Further data refinement, including the consolidation of redundant, bi-lateral structures revealed 18 subregions with significant changes in both volume and T2*. The data refinement revealed that the most represented system was the olfactory system (8/18 regions, 44%). The olfactory regions also showed the most pronounced changes and greatest correlation between the two metrics. Conclusions: These findings are suggestive that ionizing radiation may cause a pronounced disruption in the olfactory system that coincides with potential iron accumulation. Full article

Background and Objectives: Human immunodeficiency virus (HIV) has a profound impact on the central nervous system (CNS), contributing to cognitive impairment and depressive symptoms even in individuals receiving combination antiretroviral therapy (cART). This study aimed to investigate the associations between brain parenchymal volumes and neuropsychological outcomes, specifically focusing on cognitive function and depressive symptoms in HIV-positive males. Materials and Methods: A total of 48 male participants underwent cognitive assessment using the Mini-Mental State Examination (MMSE), while depressive symptoms were evaluated in 35 participants using the Beck Depression Inventory (BDI). Volumetric brain analysis was conducted through automated imaging software, volBrain (Version 1.0, published on 23 November 2021), ensuring high consistency and accuracy. Statistical analyses included Pearson correlation to identify relationships between brain volumes and neuropsychological outcomes, emphasizing key regions like the basal forebrain and cingulate gyrus. Results: Significant trends were observed between basal forebrain volume and MMSE scores, emphasizing the role of this region in cognitive regulation. Additional correlations were found with the anterior and middle cingulate gyri, which are crucial for executive functioning and attentional control. Notably, smaller right basal forebrain volumes were associated with greater depressive symptom severity, suggesting the region’s specific involvement in mood regulation. These findings highlight the dual impact of HIV on cognitive and emotional health, with structural vulnerabilities in key brain regions playing a central role. Conclusions: This study underscores the selective vulnerability of certain brain regions, such as the basal forebrain and cingulate gyrus, to HIV-associated neurodegeneration. The results highlight the importance of integrating neuroimaging and neuropsychological assessments in routine clinical care for HIV-positive individuals. The study emphasizes the importance of early detection and targeted interventions to address neuropsychological challenges in this population, with a call for further research in larger and more diverse cohorts. Full article

Background/Objectives: Infant FreeSurfer was introduced to address robust quantification and segmentation in the infant brain. The purpose of this study is to develop a new model for predicting the long-term neurodevelopmental outcomes of very low birth weight preterm infants using automated volumetry extracted from term-equivalent age (TEA) brain MRIs, diffusion tensor imaging, and clinical information. Methods: Preterm infants hospitalized at Severance Children’s Hospital, born between January 2012 and December 2019, were consecutively enrolled. Inclusion criteria included infants with birth weights under 1500 g who underwent both TEA MRI and Bayley Scales of Infant and Toddler Development, Second Edition (BSID-II), assessments at 18–24 months of corrected age (CA). Brain volumetric information was derived from Infant FreeSurfer using 3D T1WI of TEA MRI. Mean and standard deviation of fractional anisotropy of posterior limb of internal capsules were measured. Demographic information and comorbidities were used as clinical information. Study cohorts were split into training and test sets with a 7:3 ratio. Random forest and logistic regression models were developed to predict low Psychomotor Development Index (PDI < 85) and low Mental Development Index (MDI < 85), respectively. Performance metrics, including the area under the receiver operating curve (AUROC), accuracy, sensitivity, precision, and F1 score, were evaluated in the test set. Results: A total of 150 patient data were analyzed. For predicting low PDI, the random forest classifier was employed. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.8435, 0.7281, and 0.9297, respectively. To predict low MDI, a logistic regression model was chosen. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.7483, 0.7052, and 0.7755, respectively. The model incorporating both clinical variables and MR volumetry exhibited the highest AUROC values for both PDI and MDI prediction. Conclusions: This study presents a promising new prediction model utilizing an automated volumetry algorithm to distinguish long-term psychomotor developmental outcomes in preterm infants. Further research and validation are required for its clinical application. Full article

Work-related musculoskeletal disorders are prevalent in occupations requiring prolonged standing and repetitive movements, often leading to vascular issues and reduced static balance. Innovations in wearable technology, such as smart footwear integrating active systems, aim to mitigate these challenges. This exploratory study assessed the effects of a novel active footwear system, incorporating compression and vibration, on vascular blood flow and static balance in healthy adults. Sixteen healthy participants (seven men and nine women) were randomized into active and placebo phases, each involving repetitive tasks. Outcomes included reflection photoplethysmography, postural sway, and foot volumetry. Data were analyzed pre- and post-intervention, with statistical significance set at p < 0.05. For men, significant improvements in reflection photoplethysmography median values were observed post-active phase (p = 0.031), while women showed no change. Enhanced static balance, reflected in decreased total sway (p = 0.025), was noted in women. No significant changes occurred during the placebo phase. The active system improved vascular function in men and static balance in women, highlighting its potential for ergonomic interventions in industrial settings. Future studies should explore long-term effects and applications in diverse populations, including those with work-related musculoskeletal disorders. Full article

Background/Objectives: Correct pulmonary nodule volumetry and categorization is paramount for accurate diagnosis in lung cancer screening programs. CT scanners with slice thicknesses of multiple millimetres are still common worldwide, and slice thickness has an adverse effect on the accuracy of the pulmonary nodule volumetry. Methods: We propose a deep learning based super-resolution technique to generate thin-slice CT images from thick-slice CT images. Analysis of the lung nodule volumetry and categorization accuracy was performed using commercially available AI-based lung cancer screening software. Results: The accuracy of pulmonary nodule categorization increased from 72.7 percent to 94.5 percent when thick-slice CT images were converted to generated-thin-slice CT images. Conclusions: Applying the super-resolution-based slice generation on thick-slice CT images prior to automatic nodule evaluation significantly increases the accuracy of pulmonary nodule volumetry and corresponding pulmonary nodule category. Full article

Background/Objectives: Accurate volumetric assessment of lung nodules is an essential element of low-dose lung cancer screening programs. Current guidance recommends applying specific thresholds to measured nodule volume to make the following clinical decisions. In reality, however, CT scans often have heterogeneous slice thickness which is known to adversely impact the accuracy of nodule volume assessment. Methods: In this study, a deep learning (DL)-based 3D super-resolution method is proposed for generating thin-slice CT images from heterogeneous thick-slice CT images in lung cancer screening. We evaluated the performance in a qualitative way by radiologist’s perceptual assessment as well as in a quantitative way by accuracy of nodule volume measurements and agreement of volume-based Lung-RADS nodule category. Results: A 5-point Likert scale tabulated by two radiologists showed that the quality of DL-generated thin-slice images from thick-slice CT images were on a par with the image quality of ground truth thin-slice CT images. Furthermore, thick- and thin-slice CT images had a nodule volume difference of 52.2 percent on average which was reduced to a 15.7 percent difference with DL-generated thin-slice CT. In addition, the proposed method increased the agreement of lung nodule categorization using Lung-RADS by 74 percent. Conclusions: The proposed DL approach for slice thickness normalization has a potential for improving the accuracy of lung nodule volumetry and facilitating more reliable early lung nodule detection. Full article

Background/Aims: This cross-sectional study investigates body composition and strength in female breast cancer survivors, focusing on the effects of radical mastectomy and the presence of upper extremity lymphoedema. The main objective was to understand body composition, volumetry, and strength, as well as response to strength training in female breast cancer survivors. Methods: Twenty-three women (aged 42–74 years old) with radical mastectomy in the last five years were assessed by measuring body composition (weight, water percentage, fat, muscle, and lean mass), maximal strength, perimeters, and brachial volumes. Participants completed a 10-week strength training program of moderate intensity with 20 training sessions. No significant differences were found between the affected/healthy hemispheres in terms of composition, perimeters, and volumetrics. However, 11 women were found to have lymphoedema (47.8%). No statistically significant differences were found between hemibodies after the intervention, although improvements were obtained in pectoral strength and manual grip, as well as in muscle mass and lean mass [p = 0.002 each]. Cases with lymphoedema were reduced to 5 (21.73%). Conclusions: While strength training is shown to benefit body composition, strength, and the incidence of lymphoedema in mastectomized women, further scientific evidence is needed with larger controlled trials and follow-up studies to validate these findings, as well as the impact on the quality of life of these survivors. Full article