Search Results (3,315)

Ex vivo Fusion Confocal Microscopy (eFuCM) is a promising new technique for real-time histological diagnosis, requiring minimal tissue preparation and avoiding tissue waste. This study aimed to evaluate the feasibility of eFuCM in identifying key liver biopsy lesions and patterns, and to assess the impact of eFuCM reading experience on diagnostic accuracy. Twenty-three fresh liver biopsies were analyzed using eFuCM to produce H&E-like digital images, which were reviewed by two pathologists and compared with a conventional H&E diagnosis. The liver architecture was clearly visible on the eFuCM images. Pathologist 1, with no prior eFuCM experience, achieved a substantial agreement with the H&E diagnosis (κ = 0.65), while Pathologist 2, with eFuCM experience, reached almost perfect agreement (κ = 0.88). However, lower agreement levels were found in the evaluation of inflammation. Importantly, tissue preparation for eFuCM did not compromise subsequent conventional histological processing. These findings suggest that eFuCM has great potential as a time- and material-saving tool in liver pathology, though its diagnostic accuracy improves with pathologist experience, indicating that there is a learning curve related to its use. Full article

Background: This study aimed to analyze image biomarkers of the parotid glands in ultrasonography images with reduced shape effects, providing a reference for the radiomic diagnosis of parotid gland lesions. Methods: Ultrasound (US) and sialography images of the parotid glands, acquired from September 2019 to March 2024, were reviewed along with their clinical information. Parotid glands diagnosed as within the normal range were included. Overall, 91 US images depicting the largest portion of the parotid glands were selected for radiomic feature extraction. Regions of interest were drawn twice on 50 images using different shapes to assess the intraclass correlation coefficient (ICC). Feature dimensions were statistically reduced by selecting features with an ICC > 0.8 and applying four statistical algorithms. The selected features were used to distinguish age and sex using the four classification models. Classification performance was evaluated using the area under the receiver operating characteristic curve (AUC), recall, and precision. Results: The combinations of the information gain ratio algorithm or stochastic gradient descent and the naïve Bayes model showed the highest AUC for both age and sex classification (AUC = 1.000). The features contributing to these classifications included the first-order and gray-level co-occurrence matrix (high-order) features, particularly discretized intensity skewness and kurtosis, intensity skewness, and GLCM angular second moment. These features also contributed to achieving one of the highest recall (0.889) and precision (0.926) values. Conclusions: The two features were the most significant factors in discriminating radiomic variations related to age and sex in US images with reduced shape effects. These radiomic findings should be assessed when diagnosing parotid gland pathology versus normal using US images and radiomics in a heterogeneous population. Full article

Vascular liver diseases (VLDs) include different pathological conditions that affect the liver vasculature at the level of the portal venous system, hepatic artery, or venous outflow system. Although serological investigations and sometimes histology might be required to clarify the underlying diagnosis, imaging has a crucial role in highlighting liver inflow or outflow obstructions and their potential causes. Cross-sectional imaging provides a panoramic view of liver vascular anatomy and parenchymal patterns of enhancement, making it extremely useful for the diagnosis and follow-up of VLDs. Nevertheless, multiparametric ultrasound analysis provides information useful for differentiating acute from chronic portal vein thrombosis, distinguishing neoplastic invasion of the portal vein from bland thrombus, and clarifying the causes of venous outflow obstruction. Color Doppler analysis measures blood flow velocity and direction, which are very important in the assessment of VLDs. Finally, liver and spleen elastography complete the assessment by providing intrahepatic and intrasplenic stiffness measurements, offering further diagnostic information. Full article

The integration of artificial intelligence (AI) into healthcare, particularly in the field of gastroenterology, marks a significant advancement in the diagnosis and treatment of pancreatic disorders. This narrative review explores the application of AI in enhancing Endoscopic Ultrasound (EUS) imaging techniques for pancreatic pathologies, focusing on developments over the past decade. Through a comprehensive literature search across several scientific databases, including PubMed, Google Scholar, and Web of Science, this paper selects and analyzes 50 studies that highlight the role, benefits, precision rates, and limitations of AI in EUS. The findings suggest that AI not only improves the quality of endoscopic procedures, as acknowledged by a majority of gastroenterologists in the UK and USA, but also offers a promising future for medical diagnostics and treatment, potentially addressing the shortage of specialists and reducing morbidity and mortality rates. Despite AI’s infancy in clinical applications and the ethical concerns regarding data privacy, its integration into EUS has enhanced diagnostic accuracy and provided minimally invasive therapeutic alternatives. This review underscores the necessity for further clinical data to evaluate the applicability and reliability of AI in healthcare, advocating for a collaborative approach between physicians and AI technologies to revolutionize the traditional clinical diagnosis and expand treatment possibilities in gastroenterology. Full article

Background: In the last years, different evidence has underlined a possible role for [11C]-methionine ([11C]MET) positron emission tomography (PET) imaging for the evaluation of lymphomas. The aim of this paper was, therefore, to review the available scientific literature focusing on this topic. Methods: A wide literature search of the PubMed/MEDLINE, Scopus and Cochrane Library databases was conducted in order to find relevant published articles investigating the role of [11C]MET in the assessment of lymphomas. Results: Eighteen studies were included in the systematic review and the main fields of application of this imaging modality were the evaluation of disease, therapy response assessment, prognostic evaluation and differential diagnosis with other pathological conditions. Conclusion: Even with heterogeneous evidence, a possible role for [11C]MET PET imaging in the assessment of lymphomas affecting both the whole body and the central nervous system was underlined. When compared to [18F]fluorodesoxyglucose ([18F]FDG) imaging, in general, similar results have been reported between the two modalities in these settings. Full article

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena. Full article

Background: Concentric vessel-wall contrast enhancement (VW-CE) of the terminal carotid artery and its proximal branches may be linked to ischemic strokes, disease activity and progression in Moyamoya disease (MMD). The objective of this retrospective cohort study is to analyze the association between VW-CE and perioperative acute ischemic stroke (PAIS) occurring within 24 h after revascularization. Methods: All previously untreated MMD patients who required revascularization and who had undergone preoperative MRI with VW-CE-sequences were included. PAIS was detected by CT and/or diffusion-weighted MRI sequences within 24 h postoperatively. Results: Of the 110 patients included (female-to-male ratio: 2.7:1, median age: 45.1 (16.6–69.2); n = 247 revascularizations), a priori VW-CE was present in 67.3% (mean time from MRI to first surgery: 86 days ± 82 days). PAIS occurred in five patients undergoing primary revascularization (PAIS rate per revascularization: 2.1%), all of whom had a preoperative pathological VW-CE in the vascular segment corresponding to the stroke area. Two (40%) incidents of PAIS occurred in revascularized territory, while three (60%) occurred in non-revascularized vascular territory. In each case, the supplying artery exhibited VW-CE, indicating disease activity. No additional PAIS occurred during subsequent revascularizations in cases of multistage procedures (n = 38), such as ACA or PCA revascularization as a second step. Conclusion: Preoperative VW-CE in one or more vascular segments may be a marker for postoperative stroke in the respective vascular territory at the time of revascularization. VW-CE imaging should be routinely performed when planning revascularization in MMD. If VW-CE is found, strict perioperative monitoring of these high-risk patients should be performed to achieve the best results possible. Full article

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Isolated lesions of the spinous process, although less common, are some of the lesions that may be encountered and can present a diagnostic dilemma. These can range from congenital abnormalities, traumatic lesions, neoplasms and lesions of inflammatory, infective and metabolic aetiology. The literature specifically reviewing these lesions is sparse. The article reviews a range of pathologies affecting the spinous process, along with their pertinent imaging features, based on isolated pathologies of spinous process lesions identified on imaging by the authors at a tertiary orthopaedic centre over a 10-year period. A search on the hospital Picture Archive and Communication System (PACS) and Radiology Information System (RIS) was performed using the keyword “spinous process” and a list of the isolated pathologies of the spinous process based on the imaging reports was compiled for the purpose of this narrative review. It is important that radiologists consider these lesions when they are identified on routine imaging of the spine. Full article

Retinal vessel segmentation is crucial for diagnosing and monitoring ophthalmic and systemic diseases. Optical Coherence Tomography Angiography (OCTA) enables detailed imaging of the retinal microvasculature, but existing methods for OCTA segmentation face significant limitations, such as susceptibility to noise, difficulty in handling class imbalance, and challenges in accurately segmenting complex vascular morphologies. In this study, we propose VDMNet, a novel segmentation network designed to overcome these challenges by integrating several advanced components. Firstly, we introduce the Fast Multi-Head Self-Attention (FastMHSA) module to effectively capture both global and local features, enhancing the network’s robustness against complex backgrounds and pathological interference. Secondly, the Vessel Dynamic Convolution (VDConv) module is designed to dynamically adapt to curved and crossing vessels, thereby improving the segmentation of complex morphologies. Furthermore, we employ the Multi-Scale Fusion (MSF) mechanism to aggregate features across multiple scales, enhancing the detection of fine vessels while maintaining vascular continuity. Finally, we propose Weighted Asymmetric Focal Tversky Loss (WAFT Loss) to address class imbalance issues, focusing on the accurate segmentation of small and difficult-to-detect vessels. The proposed framework was evaluated on the publicly available ROSE-1 and OCTA-3M datasets. Experimental results demonstrated that our model effectively preserved the edge information of tiny vessels and achieved state-of-the-art performance in retinal vessel segmentation across several evaluation metrics. These improvements highlight VDMNet’s superior ability to capture both fine vascular details and overall vessel connectivity, making it a robust solution for retinal vessel segmentation. Full article

Eye diseases such as age-related macular degeneration (AMD) are major causes of irreversible vision loss. Early and accurate detection of these diseases is essential for effective management. Optical coherence tomography (OCT) imaging provides clinicians with in vivo, cross-sectional views of the retina, enabling the identification of key pathological features. However, manual interpretation of OCT scans is labor-intensive and prone to variability, often leading to diagnostic inconsistencies. To address this, we leveraged the RETFound model, a foundation model pretrained on 1.6 million unlabeled retinal OCT images, to automate the classification of key disease signatures on OCT. We finetuned RETFound and compared its performance with the widely used ResNet-50 model, using single-task and multitask modes. The dataset included 1770 labeled B-scans with various disease features, including subretinal fluid (SRF), intraretinal fluid (IRF), drusen, and pigment epithelial detachment (PED). The performance was evaluated using accuracy and AUC-ROC values, which ranged across models from 0.75 to 0.77 and 0.75 to 0.80, respectively. RETFound models display comparable specificity and sensitivity to ResNet-50 models overall, making it also a promising tool for retinal disease diagnosis. These findings suggest that RETFound may offer improved diagnostic accuracy and interpretability for specific tasks, potentially aiding clinicians in more efficient and reliable OCT image analysis. Full article

Background: This study investigates the role of Diffusion Tensor Imaging (DTI) in predicting the response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer. Methods: A Diffusion Tensor Imaging magnetic resonance imaging (DTI MRI) sequence, evaluating water diffusion along tissue structures, was performed before and after two chemotherapy cycles. This study included 23 patients with 27 malignant masses, comparing changes in DTI parameters with Residual Cancer Burden (RCB) scores. Results: We found a significant correlation between changes in specific DTI parameters (e.g., λ2, FA, RA) and pathological response, suggesting that DTI could serve as a sensitive marker for early chemotherapy response. However, differences in sensitivity were observed between DTI sequences with 6 and 12 directions, indicating that 12-direction DTI may provide better diagnostic accuracy. The percentage change in DTI parameters, particularly FA, demonstrated a strong ability to predict pathological complete response (pCR) with high sensitivity. Conclusions: As a non-invasive tool, DTI has the potential to assess chemotherapy efficacy, although larger studies with standardized protocols are necessary to validate its clinical utility. Full article

Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of heart muscle disorders that affects millions, with an incidence from 1 in 500 to 1 in 200. Factors such as genetics, age, gender, comorbidities, and environmental factors may contribute to the course of this disease. Diagnosis of HCM has improved significantly in the past few decades from simple echocardiographic evaluations to a more complex, multimodal approach embracing advanced imaging, genetic, and biomarker studies. This review focuses on Mavacamten, a selective allosteric inhibitor of cardiac myosin, as a pharmacological treatment for HCM. Patients with HCM experience pathological actomyosin interactions, leading to impaired relaxation and increased energy expenditure. Mavacamten decreases available myosin heads, reducing actomyosin cross-bridges during systole and diastole. By reducing the number of bridges left ventricular outflow tract pressure is normalized and cardiac cavities are filled. This mechanism enhances patient performance and alleviates symptoms such as chest pain and dyspnea. The results suggest the potential for Mavacamten to transform the treatment of obstructive hypertrophic cardiomyopathy. Studies to date have shown significant improvement in exercise capacity, symptom relief, and a reduction in the need for invasive procedures such as septal myectomy. Further studies are needed to confirm the clinical results. Full article

Lung cancer associated with cystic airspaces (LCCA) is a rare subtype of non-small-cell lung cancer (NSCLC), accounting for 1–4% of cases. LCCA is characterized by the presence of cystic airspaces within or at the periphery of the tumor on imaging. LCCA poses significant clinical challenges due to its high risk of misdiagnosis or missed diagnosis, often leading to a worse prognosis compared to other forms of lung cancer. While previous studies have identified correlations between the pathological features and imaging characteristics of LCCA, research on its associated driver gene mutations and responses to chemotherapy and immunotherapy remains limited. Furthermore, the development of an appropriate T-staging system is necessary to improve prognostic outcomes. This review provides an overview of the current research on the definition, imaging classification, pathological and molecular mechanisms, and prognosis of LCCA, aiming to provide a reference for clinical decision-making. Full article

Background and Aim: Ex vivo fluorescence confocal microscopy (FCM) systems are innovative optical imaging tools that create virtual high-resolution histological images without any standard tissue processing, either freezing or fixing in formalin and embedding in paraffin. These systems have opened an era that would revolutionize pathological examination by providing rapid, real-time assessments across various pathology subspecialties, potentially replacing conventional methods that are tissue- and time-consuming. This study aimed to present the first utilization of FCM in pediatric surgical oncology, focusing on assessing the benefits, particularly in facilitating rapid and accurate diagnosis. Methods: This preliminary study comprised five consecutive patients undergoing surgical biopsy for disease characterization and surgical strategy selection. After biopsy, tissue samples were prepared and analyzed using FCM without sectioning. A pathologist who evaluated macroscopic and microscopic images, once obtained remotely, could promptly indicate any interventions that require timeliness. Samples were then evaluated with conventional methods. Results: All five lesions were deemed suitable for evaluation. Preliminary diagnoses utilizing FCM included atypical Spitz nevus (1), Wilm’s tumor (1), lymph node reactive hyperplasia (1), malignant germ cell tumor of the testis (1), and Hodgkin’s lymphoma (1). Final histopathological analyses revealed atypical Spitz nevus (1), Wilm’s tumor (1), hyperplastic lymphadenopathy with a prevalent marginal pattern (1), mixed nonseminomatous malignant germinal neoplasm consisting of embryonal carcinoma (90%) and yolk sac tumor (10%), and Hodgkin’s lymphoma nodular sclerosis variant (1). In the case of diagnosis of atypical Spitz nevus, the widening of the resection margins was performed in the same surgery. In the case of testicular neoplasm, radical orchiectomy was performed. A high level of agreement between FCM evaluation and definitive histological examination was observed for all parameters evaluated. Conclusions: FCM represents a significant advancement in pathological imaging technology, offering potential benefits in enhancing traditional tissue processing methods. This preliminary report marks the first application of FCM in pediatric surgical oncology. Our findings underscore the promising role of FCM as an adjunctive tool in pediatric oncology, facilitating prompt diagnosis and treatment initiation. Full article

Background and Objectives: Primary prostatic stromal sarcoma is an exceptionally rare urological malignancy, constituting less than 0.1% of all prostatic cancers. It poses a significant clinical challenge due to its aggressive behavior and poor prognosis. Materials and Methods: We report the case of a 34-year-old male who presented with nonspecific lower urinary tract symptoms, including dysuria and increased urinary frequency. The initial diagnostic workup, including digital rectal examination and Magnetic Resonance Imaging (MRI), revealed a lobulated lesion within the prostate. A transurethral resection (TUR) was performed for diagnostic purposes, and histopathological examination revealed a “malignant mesenchymal tumor”. The patient underwent a laparoscopic radical prostatectomy. The pathology report confirmed the diagnosis of prostatic stromal sarcoma. The postoperative follow-up, including systemic CT and MRI, showed no evidence of recurrence or metastasis thus far. Results: Multidisciplinary management is essential for optimizing treatment outcomes in all urologic malignancies; however, it becomes particularly challenging and crucial in rare cases such as primary prostatic stromal sarcoma. In our case, the patient benefited from a coordinated approach involving urology, pathology, and oncology, underscoring the importance of collaborative care for rare and aggressive tumors like this. This case highlights the importance of early detection, complete surgical excision, and consideration of adjuvant therapies, given the aggressive nature of the disease. The role of novel therapeutic strategies, including immunotherapy and targeted therapies, is also discussed in the context of metastatic sarcomas. Conclusions: This case underscores the critical need for a comprehensive, multidisciplinary approach to managing primary prostatic stromal sarcoma. Ongoing research on innovative therapies offers hope for improved outcomes in metastatic stages. Full article