Objective This study aimed to determine the short-term effects of a research methodology course (intervention) on knowledge enhancement of participants from economically emerging (cohort 1) and economically developed (cohort 2) countries; and to determine the long-term publication trajectory of course participants from the time of intervention (timepoint 1 (T1)) to 10 years post-course (timepoint 2 (T2)). Participants/setting Residents/fellows/junior staff from academic institutions of cohorts 1 and 2 completed a four-day research course divided into research design (M1) and statistics (M2) modules. Intervention A 30-item multiple-choice pre-test was provided at the beginning and end of the course for M1 and M2. Pre-/post-test scores assessed knowledge enhancement. A PubMed search (1966-2024) was conducted to evaluate the number, impact factor (IF), and authorship of publications until T1 and T2. Results  In cohort 1, 21 (100%) participants (male-to-female ratio: 11:10; six residents and 15 fellows/junior staff) aspired to an academic career; in cohort 2 (male-to-female ratio: 12:7), 12/19 (63%) (seven residents and five fellows/junior staff) did. At T1, differences were noted between pre- and post-test scores for cohort 1 in M1 (p=0.0005) and M2 (p=0.001), but only for M2 (p=0.01) for cohort 2. For aspiring academicians, whereas the mean number of publications/person was similar between cohort 1 (N=1.1) and cohort 2 (N=2.75) at T1 (p=0.12), it was higher for cohort 2 (N=27.4 vs. N=8.95) at T2 (p=0.03), with similar mean IF of publications for cohorts 1 and 2 at T1 and T2 (p>0.05). Conclusion In the short term, radiology trainees from both countries benefited from the educational research program, particularly in statistics. Over a decade, whereas the quality (IF) of publications remained stable for academicians of both countries, the publication output/person remained stable for cohort 2 participants but declined for cohort 1 participants.
Aortic root (AoR) dilatation is a condition that requires monitoring of its growth through serial imaging studies in order to determine appropriate treatment. Systematic differences in AoR measurements have been reported between transthoracic echocardiography (TTE) and cross-sectional imaging techniques. The aim of this study was to determine which AoR measurement-performed using cardiac computed tomography angiography (CCTA) in patients with tricuspid aortic valves-shows the best correlation with the standard measurement obtained by TTE. A retrospective analysis was conducted on 110 patients who underwent both CCTA and TTE within a six-month interval at our institution, including an equal number of patients with and without AoR dilatation. On the transverse plane of the AoR in CCTA, the following measurements were taken: cusp-to-commissure, cusp-to-cusp, area, area-derived diameter (ADD) and anteroposterior diameter (APD). CCTA measurements showed excellent correlation with TTE (p < 0.001), with the highest degree of agreement observed for ADD and APD (both p < 0.001). APD measurements did not differ significantly from those obtained by TTE in any group (overall p = 0.451; non-dilated AoR p = 0.427; dilated AoR p = 0.091), in contrast to the other measurements, including ADD. The APD measurement obtained by CCTA proved to be equivalent to that obtained by TTE, easy to perform and highly reproducible. Future research may establish APD as the reference measurement for comparing results between both techniques.
Basilar artery occlusion (BAO) accounts for 10% of all ischemic strokes due to largevessel occlusion (LVO) and is associated with highest mortality and disability rate. The aim ofthis study is to propose a specific basilar artery reperfusion score based on digital subtraction angiography (DSA) to evaluate the efficacyof mechanical thrombectomy in patients with acute BAO. We conducted a retrospective analysis of a prospective database of consecutivepatients with acute BAO treated with mechanical thrombectomy within 24 h from symptomonset at a comprehensive stroke center between January-2014 and December-2023. BasilarThrombolysis In Cerebral Infarction (bTICI) scale was made using PC ASPECTS grading scoreas reference. Primary outcome was defined by a modified Rankin scale score of 0-3 (goodfunctional status) at 90-days. A total of 98 patients were included (median age 70 years, 56 men). bTICI score of 10was achieved in 46 patients (46.9%), bTICI 9 in 8 patients (8.2%), bTICI 8 in 16 patients (16.3%), bTICI 7 in 4 patients (4.1%) and bTICI 0-6 in 24 patients (24.5%). On multivariable analysis, mTICI 3 was independently associated with 90-day goodfunctional status [OR 4.48 (95% CI 1.64-18.27)], while mTICI 2b-3 was not. Regarding bTICI scale, a bTICI ≥ 7 remained as independentpredictors of 90-day good functional status [OR 9.45 (95% CI 2.68-33.30)]. In our study, bTICI ≥ 7 or ≥8 is an independent predictor of 90-day good functional status (mRS 0-3) in patientswith Acute BAO treated with mechanical thrombectomy. The Basilar Thrombolysis In Cerebral Infarction (bTICI) scale identified meaningful distinctions in clinical outcomes in our single-center study, showing better performance thanmTICI scale. This new scale, specific to posterior circulation stroke, may be useful in futurestudies and routine practice but this needs to be confirmed in multicenter.
Background/Objectives: Accurate identification of neonatal malnutrition is essential for optimizing perinatal care and reducing adverse outcomes. Traditional birthweight-based methods fail to account for body proportionality, limiting their ability to distinguish constitutionally small or large neonates from those with true nutritional abnormalities. We previously developed a customized fetal body mass index (cFBMI) percentile model that incorporates both weight and length, adjusted for maternal and fetal characteristics. This study aims to perform a temporal external validation of the cFBMI model following the Riley et al. framework, comparing its performance against the GROW customized birthweight model and the INTERGROWTH-21st population-based standard. Methods: A temporal validation study was conducted using singleton deliveries from Hospital Universitario de Puerto Real, Cádiz, Spain. The development cohort comprised 7864 deliveries (2002-2021); the validation cohort comprised 4441 deliveries (2022-2025). Inclusion criteria: singleton pregnancy, gestational age of 33-42 + 6 weeks, birthweight of 500-6000 g, known neonatal sex and length, and complete maternal data. The Ponderal Index (PI = weight/length3 × 100) stratified by sex and gestational age served as the gold standard (undernutrition: PI < p10; overnutrition: PI > p90). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap 95% confidence intervals (2000 iterations) and DeLong tests. Calibration was evaluated by comparing observed versus expected proportions across percentile categories. Clinical utility was assessed using decision curve analysis (DCA). Temporal stability was quantified by comparing AUCs and Brier scores between the development and validation cohorts. Results: In the validation cohort (n = 4441), cFBMI demonstrated superior discrimination for both undernutrition (AUC: 0.962) and overnutrition (AUC: 0.961) compared with GROW (AUC: 0.751 and 0.676, respectively) and INTERGROWTH-21st (AUC: 0.756 and 0.682, respectively); all DeLong comparisons p < 0.0001. The cFBMI exhibited excellent temporal stability (ΔAUC = -0.004 for undernutrition, +0.002 for overnutrition) and superior calibration (observed proportions: 9.6%/81.7%/8.8% vs. expected 10%/80%/10%; χ2 = 9.22, p = 0.010). The decision curve analysis confirmed the superior net benefit of cFBMI across all threshold probabilities. Conclusions: The customized fetal BMI percentile model demonstrates excellent and temporally stable discriminative performance in this single-institution temporal validation study, with superior calibration and apparent advantages in clinical utility as determined by decision curve analysis compared with existing methods. Its integration of body proportionality provides conceptual alignment with the Ponderal Index gold standard. These findings are promising but require confirmation through external multicenter validation before clinical implementation can be recommended. Although the mathematical relationship between the index test (weight/length2) and the reference standard (weight/length3) should be considered when interpreting the magnitude of discrimination metrics, validation against independent clinical outcomes is an essential next step. The cFBMI thus provides a proportionality-aware nutritional metric whose primary discriminative advantage over weight-based methods is realized at and beyond the moment of birth, and which is forward-compatible with emerging modalities for independent prenatal fetal length estimation.
Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. We included individuals aged ≥ 50 years and excluded those with dorsolumbar scoliosis. We built a multivariate log-linear regression model to identify factors associated with AAT. The model was adjusted by carotid calcification, stiffness, and stenosis as well as individual clinical characteristics and previously registered vascular diseases. A total of 490 individuals (mean age, 66.92 years; range, 50-98 years; 44.29% of women) from the Ageing Imageomics Study were included in this analysis. We observed that the AAT index was strongly dependent on age and also with diastolic blood pressure and estimated glomerular filtration rate (eGFR), but to a lesser extent. In contrast, other classical cardiovascular risk factors like diabetes mellitus, hypertension, smoking, aortic stiffness, and calcification did not play a significant role. Our results do not support the AAT index as a subclinical marker of cardiac, cerebrovascular, or peripheral vascular disease. AAT was not associated with classical cardiovascular risk factors and comorbidities.
Thediagnosis of Cushing syndrome can be challenging, particularly when bilateral inferior petrosal sinus sampling (BIPSS) is required to differentiate ectopic tumors from pituitary adrenocorticotropic hormone (ACTH)-releasing tumors. When corticotropin-releasing hormone (CRH) is used as a stimulus, a state of hypercortisolism is required to suppress CRH receptors in pituitary corticotrophs, preventing the release of ACTH by normal pituitary tissue. By contrast, desmopressin acts through vasopressin receptors that are preferentially expressed in ACTH-secreting pituitary tumors, suggesting potentially different physiological behaviors during stimulation. We present the case of a 26-year-old woman with ACTH-dependent Cushing's syndrome who underwent desmopressin-stimulated BIPSS. Hormone levels on the day of catheterization indicated eucortisolism; however, ACTH levels in the petrosal sinus confirmed the diagnosis of Cushing disease. Following transsphenoidal surgery, immunohistochemical analysis confirmed a corticotroph adenoma with positive Tpit and ACTH staining. We hypothesize that desmopressin stimulation during BIPSS may provide diagnostic information even in the absence of biochemical confirmation of hypercortisolism at the time of the procedure, because vasopressin receptors are expressed in pituitary corticotroph adenomas rather than in normal corticotroph cells. Further studies are needed to evaluate and confirm this hypothesis.
Peptic ulcer disease remains one of the leading causes of non-variceal upper gastrointestinal bleeding. Despite advances in endoscopic therapy and pharmacological management, recurrent bleeding continues to represent a major cause of morbidity and mortality. Risk stratification is traditionally based on endoscopic stigmata according to the Forrest classification; however, ulcers with similar endoscopic findings may exhibit markedly different clinical outcomes. Increasing evidence suggests that ulcer-related anatomical factors, including size, location, and depth of penetration, may influence the risk of severe or recurrent hemorrhage, particularly in cases involving adjacent arterial structures. In this conceptual, hypothesis-generating review, we propose a conceptual bi-dimensional framework integrating endoscopic and anatomical determinants of bleeding risk. This approach aims to improve patient stratification by identifying a subgroup at "very-high-risk" of recurrent bleeding, in whom standard endoscopic therapy alone may be insufficient. Although this framework is hypothesis-generating and not yet validated, it may provide a conceptual basis for future studies aimed at improving individualized management strategies, including early imaging assessment and consideration of transarterial embolization in selected high-risk patients.
Long COVID is a multisystem condition with challenging diagnosis. Nurse-navigation, a patient-centered intervention, can enhance education and care access. Analyzing patient-nurse text message exchanges using natural language processing (NLP) enables automated extraction of clinical information, potentially supporting early identification of long COVID. We aimed to evaluate a digital nurse navigation platform integrating a predictive model for long COVID identification as a triage-assisting tool and to assess user acceptance. This observational study included patients and healthcare professionals diagnosed with COVID-19 from January to July 2024. Participants received nurse-navigation support for 16 weeks with monthly interactions via a WhatsApp-integrated platform. Structured sociodemographic and clinical data were combined with text-message insights using NLP techniques such as term frequency-inverse document frequency (TF-IDF), and analyzed using language models (Gemini 1.5 Pro, BERTimbau) and probabilistic linkage. The dataset was split into 70% training and 30% testing, and eight machine learning models were evaluated. Performance metrics included accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC). User satisfaction was assessed with the Net Promoter Score (NPS). Among 177 participants, 141 (78%) were female, with an overall mean age of 51 years. A total of 7,016 messages were processed. Long COVID was identified in 60 participants (33%), most frequently reporting memory loss, dyspnea, cognitive fatigue, and hair loss. Participants received structured education, and 20 were referred for further evaluation. The XGBoost-minor model achieved the highest classification performance with an accuracy of 72%, sensitivity of 38%, specificity of 88%, PPV of 63%, NPV of 74%, and AUROC 0.59. Predictive factors included age, COVID-19 episodes, vaccination, comorbidities, and respiratory symptoms. The NPS was 92, indicating strong endorsement. An AI-enhanced triage process within nurse navigation represents a promising and scalable strategy to support the identification and monitoring of patients at risk for long COVID.
Hepatic storage diseases compromise the integrity of the hepatic parenchyma, with their natural progression leading to liver fibrosis. This article reviews the pathophysiology and radiological characteristics associated with the main aetiologies of hepatic storage diseases, and provides a practical guide on the new diagnostic modalities available for their study.
Penile pathology encompasses a wide spectrum of conditions. Among the most common lesions are vascular abnormalities (Mondor's disease, thrombosis of the corpus cavernosum, erectile dysfunction and priapism), traumatic injuries (penile fracture, intracavernous and extraalbugineal haematomas), inflammatory and infectious processes (abscess and gangrenous cavernositis), benign lesions (Peyronie's disease and others) and malignant lesions (both primary and metastatic). A radiologist's knowledge of these conditions is fundamental for accurate diagnosis and appropriate treatment, with a significant potential impact on both quality of life and clinical management. The aim of this article is to illustrate the key imaging findings of the main penile pathologies using different imaging modalities and to review the principal differential diagnoses through representative cases.
To investigate demographic, morphologic, and morphometric variables associated with early or subclinical imaging-based osteoarthritic structural changes of temporomandibular joint (TMJ). Cone-beam computed tomography scans of 396 TMJs from 198 asymptomatic individuals (75 males, 123 females) were analyzed. TMJs were classified as normal-appearing, indeterminate for osteoarthritis (OA), or affected by OA based on condyle, and fossa/eminence morphology. Univariate and multivariate logistic regression models assessed the association of 5 patient-level and 20 TMJ-level variables with the indeterminate or affected by OA status, adjusting for confounding. Prevalence rates of the indeterminate and affected by OA statuses were 25.80% and 33.30% at the patient-level and 25.30% and 24.50% at the TMJ-level, respectively. Whereas complete/partial edentulism was the only strong/independent indicator for indeterminate for OA category, strong indicators associated with the affected by OA status included age > 38.50 years, complete/partial edentulism, Class II skeletal relationship, horizontal condylar angle ≥ 24.14 degrees, condylar height ≤ 16.00 mm, sagittal glenoid fossa width > 16.95 mm, sagittal articular eminence angle ≤ 45.78 degrees, glenoid fossa roof thickness > 1.23 mm (coronal) and > 1.20 mm (sagittal). CBCT imaging provides a reliable framework for identifying both established and early osteoarthritic changes in the TMJ of asymptomatic adults. Indeterminate cases, often marked by flattening or sclerosis, should be regarded as transitional stages that warrant closer monitoring.
Porto-sinusoidal vascular disease (PSVD) is an uncommon disorder characterized by hepatic microvascular alterations and noncirrhotic portal hypertension. Its recent redefinition includes patients with and without portal hypertension, even in the presence of concomitant liver disease. The present study aimed to correlate the clinical, radiologic, and histopathologic findings in Mexican patients with PSVD and identify key diagnostic challenges. A retrospective study was conducted on ten patients diagnosed with PSVD according to updated criteria, in whom liver biopsy showed no cirrhosis. Clinical, laboratory, imaging, and histopathologic data were collected. Upper gastrointestinal bleeding was the most frequent initial presentation, followed by mild thrombocytopenia. Biopsies revealed obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Magnetic resonance imaging identified periportal hyperintensity, which aided in differentiating PSVD from cirrhosis. The findings confirm PSVD heterogeneity, underscoring the importance of integrating different diagnostic tools for its timely detection.
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This cross-sectional study evaluated the 12-lead electrocardiogram (ECG) corrected QT (QTc) interval as an accessible marker for organ-specific iron burden in adult patients with transfusion-dependent thalassemia (TDT). We considered 273 adult TDT patients (37.48 ± 8.75 years; 53.8% females), enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. All patients underwent magnetic resonance imaging (MRI) for the quantification of hepatic, pancreatic, and myocardial iron ( T 2 * $$ {T}_2^{\ast } $$ technique) and the assessment of biventricular size and function, alongside a standard ECG within 3 months. QTc interval showed a significant negative correlation with pancreatic T 2 * $$ {T}_2^{\ast } $$ (R = 0.220; p < 0.0001) and cardiac T 2 * $$ {T}_2^{\ast } $$ (R = -0.201; p = 0.001). A QTc > 425 ms predicted myocardial iron overload (MIO; T 2 * $$ {T}_2^{\ast } $$  < 20 ms). A significant stepwise prolongation of the QTc interval was observed across groups: no iron overload (405.45 ms), isolated pancreatic siderosis (421.76 ms), and combined pancreatic/myocardial siderosis (433.01 ms) (p = 0.001). In patients without MIO, a QTc > 416 ms predicted pancreatic siderosis ( T 2 * $$ {T}_2^{\ast } $$  < 26 ms) and a multivariable regression analysis confirmed pancreatic iron, female sex, and splenectomy as independent predictors of QTc duration. The QTc interval may serve as an early "metabolic sensor" of multi-organ iron toxicity. A QTc > 416 ms is associated with pancreatic siderosis and possible cardiac risk before MRI detects cardiac iron. While QTc alone is unlikely to be sufficient for individual patient risk stratification, this inexpensive and widely available parameter may help inform decisions regarding advanced imaging.
Parathyroid glands exhibit a notable anatomical variability, complicating preoperative localization. Minimally invasive parathyroidectomy ideally requires two concordant imaging tests. This study aims to evaluate the degree of concordance of the different tests available with surgical findings and to create an algorithm to discern the order in which these tests should be performed. This prospective study included 93 patients with primary hyperparathyroidism (PHP) undergoing 99mTc-sestamibi SPECT/CT and cervical ultrasound. Discordant cases underwent secondary imaging (contrast-enhanced ultrasound [CEUS], CT, MRI, or 18F-choline PET/CT) based on endocrinologist criteria. Sensitivity, positive predictive value (PPV), accuracy, and Cohen's Kappa index (k) relative to surgical outcomes were calculated for each modality. Of the 93 patients studied, 46 (49.5 %) were included in Group A (concordant location between 99Tc-sestaMIBI and ultrasound) and 47 (50.5 %) in Group B (discordant initial tests). Overall, 99mTc-sestamibi SPECT/CT showed κ = 0.55 (p < 0.001), while ultrasound demonstrated κ = 0.67 (p < 0.001). In Group B, imaging tests yielded the following κ values: CEUS = 0.64 (p < 0.001), 18F-choline PET/CT = 0.62 (p = 0.013), CT = 0.54 (p = 0.002), ultrasound = 0.43 (p < 0.001), 99mTc-sestamibi SPECT/CT = 0.34 (p = 0.013) and MRI = 0.14 (p = 0.145). In patients with PHP with surgical criteria in whom initial scintigraphy and ultrasound were concordant, both tests showed moderate concordance with surgery. In discordant cases, CEUS showed the greatest concordance with surgery, followed by 18F-choline PET/CT. Thus, we propose an algorithm in which localization tests should be performed in a certain order based on the performance of each test in each possible scenario.
Fetal MRI has been proved to be a valuable complement to prenatal ultrasound in the study of congenital abnormalities, especially those of the central nervous system. However, its role in the assessment of the fetal abdomen is less known. Fetal abdominal pathology includes congenital abnormalities of the gastrointestinal tract, genitourinary tract, and abdominal wall defects. The aims of this article are to indicate an assessment protocol for the fetal abdomen, determine which patients will benefit from this technique and illustrate with examples the value of prenatal MRI and the role of the radiologist, both in diagnosis and perinatal management of these patients.
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Radiation segmentectomy (RS) has emerged as a promising approach for hepatocellular carcinoma (HCC), particularly when high tumor doses are achieved. While the clinical utility of ablative doses with glass microspheres is well established, data on resin microspheres remain scarce and inconsistent. This state-of-the-art review aims to provide a descriptive, hypothesis-generating overview of the available evidence and to highlight key gaps in the literature. A structured search of PubMed and Embase was conducted to identify clinical studies, technical reports, and reviews evaluating RS using resin microspheres in patients with HCC. Inclusion was limited to studies reporting dosimetric data or clinical outcomes following high-dose delivery. Both published and unpublished sources were considered to ensure a comprehensive overview. Six publications met the inclusion criteria: four studies with primary clinical data and two narrative reviews. Most were retrospective and single-center, with considerable heterogeneity in methodology and outcome reporting. Reported tumor doses varied widely, and no prospective study has validated safety or efficacy thresholds to date. Nevertheless, selected studies suggest that resin microspheres may achieve tumoricidal doses (> 300 Gy), with encouraging response rates and acceptable safety profiles in highly selective settings. The use of resin microspheres in radiation segmentectomy represents a promising, yet underexplored, therapeutic strategy in HCC. However, the current evidence base is limited, heterogeneous, and not suitable for definitive clinical conclusions. This review is intended to frame the current evidence landscape and generate hypotheses, supporting the need for prospective, standardized investigations to define optimal dosimetry and guide future research.
Infarct growth rate (IGR) is highly heterogeneous among ischemic stroke patients, reflecting a spectrum of progressor phenotypes with clinical implications. We aim to compare different imaging approaches to investigate stroke progressors phenotypes and their clinical implications in patients undergoing thrombectomy. Data are from the prospective Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients with M1/M2 occlusion and known symptom onset were included. Progressor phenotypes were defined using (1) NCCT-based definitions (ASPECTS points decay per hour < 0.25 pts/h=slow progressor, 0.25-0.50 pts/h=intermediate, and > 0.50 pts/h=fast); and (2) CTP-based definitions (CTP-estimated core divided by time of onset < 5 mL/h=slow progressors, 5-10mL/h=intermediate, and > 10 mL/h=fast). The primary outcome was 90-day good functional outcome (modified Rankin Scale [mRS] = 0-2). Associations were assessed with logistic regression analyses adjusted for age, sex, NIHSS, TICI score, thrombolysis, and imaging-to-recanalization time. Of 26799 patients screened, 8322 (31.1%) were included (NCCT group: 8076; CTP group: 897 patients). NCCT-based progressor phenotype was associated with lower odds of good outcome (aOR 0.82 [95%CI = 0.72-0.92] per each progressor phenotype increase). ASPECTS decay per hour was associated with lower odds of good outcome (acOR 0.94 [95%CI = 0.89-0.99]). No significant association was observed for either CTP-based progressor phenotype or CTP-based IGR (mL/h). Similar findings were observed for secondary outcomes. In this large, real-world cohort of stroke patients, NCCT-based IGR was associated with functional outcomes, whereas CTP-based IGR was not. This highlights the need to refine and identify more accurate markers of infarct growth within perfusion imaging.
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