Pediatric solid tumors require accurate imaging for staging, treatment planning, and follow-up. Whole-body magnetic resonance imaging has emerged as a promising radiation-free alternative to positron emission tomography-computed tomography, offering superior soft tissue contrast. This study compares the diagnostic performance of whole-body magnetic resonance imaging and positron emission tomography-computed tomography in detecting primary tumors, metastases, and recurrences in pediatric solid tumors. This retrospective study included 47 pediatric patients (27 boys and 20 girls; age range: 3-18 years; mean age: 11.3±3.5 years) with suspected or confirmed solid tumors who underwent both whole-body magnetic resonance imaging and positron emission tomography-computed tomography between 2017 and 2020. Lesional and per-patient agreement between modalities was evaluated using positron emission tomography-computed tomography as the reference. Statistical analysis was performed to assess inter-modality agreement. Positron emission tomography-computed tomography detected pathological findings in 35 patients (74.4%), including 27 primary tumors (57.4%), 18 metastases (38.2%), and one recurrence (2.1%). Whole-body magnetic resonance imaging showed high diagnostic concordance, detecting all primary tumors and the recurrence, and 16 of 18 metastatic cases. Per-lesion analysis revealed 66 lesions on positron emission tomography-computed tomography and 64 on whole-body magnetic resonance imaging, with two metastatic lesions (an ossified pulmonary metastasis and an osteoblastic femur lesion) missed by magnetic resonance imaging. Cohen's kappa (κ) for abnormality detection was 0.89, indicating almost perfect agreement (95%CI 0.75-1.00). McNemar's test showed no statistically significant difference between the modalities (p=0.479). Whole-body magnetic resonance imaging demonstrates excellent agreement with positron emission tomography-computed tomography for evaluating pediatric solid tumors, offering a radiation-free alternative, particularly advantageous in long-term follow-up. While limitations remain in detecting sclerotic metastases, whole-body magnetic resonance imaging is a primary alternative in specific scenarios.
Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction. Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity. After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed. Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.
Erector spinae plane catheters are increasingly used for rib fracture analgesia, but the influence of catheter insertion technique on catheter position and analgesic effectiveness remains uncertain. In this case series, we describe 11 erector spinae plane catheters inserted using a catheter-through-needle technique for analgesia in patients with rib fractures who underwent chest computed tomography after catheter insertion. Catheter tip position outside the intended fascial plane was identified in six of 11 (55%) catheters. Previous studies of catheter-over-needle systems have reported displacement rates of up to 89%, but cross-study comparisons are limited by small sample sizes and differences in population, catheter techniques and imaging protocols. Interpretation of clinical impact is limited. Pain score recording and analgesic prescribing were not standardised, and patients frequently had multiple injuries requiring multimodal analgesia, making it difficult to isolate the contribution of erector spinae planes catheter position to pain relief. Furthermore, computed tomography demonstrates catheter location but may not reflect local anaesthetic spread or functional block efficacy. These findings highlight clinically relevant uncertainty regarding the relationship between catheter insertion technique, catheter position and patient-centred analgesic effectiveness. Further prospective studies are needed to determine whether insertion techniques affect catheter position, injectate spread and patient-centred analgesic outcomes.
Preservation of canal dentin during rotary root canal instrumentation is essential to maintain structural tooth strength and prevent procedural mishaps. Limited data exist comparing dentin changes between contemporary nickel-titanium (NiTi) rotary systems using three-dimensional imaging. This study aims to evaluate and compare canal dentin changes following instrumentation with three NiTi rotary file systems using cone-beam computed tomography (CBCT). Sixty-six extracted human mandibular premolars with single straight canals were decoronated and randomly allocated to three groups (n = 22) based on the rotary system used: ProTaper Gold, NeoEndo Flex, and GenEndo. Canals were prepared according to the manufacturer's protocols. Pre- and post-instrumentation CBCT scans were obtained. Dentin thickness was measured at 3 mm, 6 mm, and 9 mm from the apex. Differences in dentin thickness pre- and post-instrumentation were calculated for each system. One-way analysis of variance followed by Tukey's post hoc test was performed; statistical significance was set at P < 0.05. Significant intergroup differences in dentin reduction were observed at all root levels (P < 0.001). Mean reduction (coronal-apical) was highest with ProTaper Gold (1.15-0.97 mm), intermediate with NeoEndo Flex (0.56-0.51 mm), and lowest with GenEndo (0.28-0.10 mm). Different NiTi rotary systems result in varying canal dentin changes. Among those evaluated, GenEndo preserved dentin most effectively, while ProTaper Gold resulted in greater dentin reduction. CBCT is a reliable tool for non-destructive assessment of dentin changes after instrumentation.
To evaluate the diagnostic value of multislice spiral computed tomography (MSCT) in differentiating pancreatic acinar cell carcinoma (PACC) from pancreatic ductal adenocarcinoma (PDAC). The clinical, pathological, and imaging data of 17 patients with pathologically confirmed PACC and 62 patients with PDAC were retrospectively analyzed. Quantitative variables were compared between groups using the independent samples t-test or the Mann-Whitney U test, as appropriate. Qualitative variables were compared using the Pearson's chi-square test or Fisher's exact test. Variables showing statistical significance in univariate analysis were entered into multivariate logistic regression analysis to identify independent predictors for distinguishing PACC from PDAC. Diagnostic performance was assessed using receiver operating characteristic curve analysis, with calculation of the area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Univariate analysis demonstrated significant differences between the two groups in tumor shape, margin, pancreatic atrophy, pancreatic duct transection, maximum tumor diameter, CT attenuation values, and enhancement ratios in the pancreatic parenchymal, portal venous, and delayed phases, all of which showed statistically significant differences. Multivariate logistic regression analysis identified tumor margin, pancreatic duct transection, pancreatic parenchymal phase CT attenuation value as independent predictors for distinguishing PACC from PDAC. The combined diagnostic model incorporating these variables achieved the highest diagnostic performance, with an AUC of 0.968. The model demonstrated a sensitivity of 94.1%, specificity of 88.7%, accuracy of 89.9%, positive predictive value of 69.5%, and negative predictive value of 98.2%. Tumor margin, pancreatic duct transection, and pancreatic parenchymal phase CT attenuation value are significant imaging features for differentiating PACC from PDAC. A combined diagnostic model integrating these imaging features provides excellent diagnostic performance and may aid in improving preoperative differential diagnosis.
Coal workers' pneumoconiosis (CWP) is a parenchymal lung disease resulting from the prolonged inhalation of coal dust. Coal dust exposure may also lead to a spectrum of airway and parenchymal disorders. This study aimed to investigate the clinical characteristics, radiological and functional findings of CWP, as well as the presence of interstitial changes and associated risk factors. Patients with CWP who were admitted to the occupational diseases clinic of a tertiary hospital between 2017 and 2023 were included. Demographic, radiological, and pulmonary functional data were analyzed. High-resolution computed tomography scans were reviewed for interstitial lung abnormalities (ILA) and interstitial lung disease (ILD). Factors associated with ILD were assessed using logistic regression analysis. Statistical significance was defined as p<0.05. A total of 100 male patients with CWP (mean age, 61.7 ± 11.7 years) were evaluated. Large opacities were present in 37% of cases. Pulmonary function testing revealed restrictive impairment in 35% and obstructive impairment in 38%of patients. Compared with those working lignite mines, bituminous coal miners exhibited a significantly higher prevalence of large opacities and lower lung function values. ILAs were identified in 63% of patients and ILD in 42%. ILD prevalence was significantly higher among those with exposure durations exceeding 10 years, working in bituminous coal mines, and with predominant small opacities larger than 3 mm. Coal dust exposure represents a major risk factor not only for CWP but also for lung function impairment, ILA, and ILD. Comprehensive surveillance of coal workers is essential for early detection and timely management of these conditions.
Fractures of the facial bones involving the orbit are challenging conditions that require surgical treatment. To describe preoperative and postoperative clinical and computed tomographic findings of an orbital rim fracture repaired using a reconstruction plate. Case report. A 14-year-old Haflinger mare was presented with an open, depressed and comminuted fracture involving the frontal, nasal, lacrimal and maxillary bone, sinus system and the medial aspect of the orbital rim and wall on the right side, as diagnosed by CT. Fracture repair included orbital rim reconstruction with a pre-shaped 12-hole 3.5-mm LCP-reconstruction-plate and repositioning/fixation of several fragments, including one large frontal nasal bone fragment, with cerclage wire sutures. Despite an implant infection postoperatively, the fracture healing assessed by CT 10 weeks later was considered good, and the reconstruction plate was removed at the same time. CT follow-up 1 year after fracture fixation revealed excellent restoration and healing of the orbital rim and wall. Complete resorption of the large repositioned frontal/nasal bone fragment was observed, resulting in a skin-covered bone defect adjacent to the right sinus system. CT imaging also suggested a potential mucocele formation within the right sinus system. Both findings were clinically inapparent and identified solely on CT examination. An excellent long-term outcome was achieved in this orbital fracture repaired with application of a pre-shaped 3.5-mm LCP-reconstruction plate, despite sinus communication, severe comminution and later implant infection, as assessed by CT. In conclusion, CT proved highly valuable for a systematic approach to fracture treatment and perioperative assessment of facial fractures in the present case. Several findings that had not been previously described could be characterised for the first time based on CT assessment. However, the long-term clinical relevance of the described findings needs further evaluation.
The purpose of this study was to quantify the three-dimensional distribution of estimated acetabular bone requiring reaming during virtual cup placement in total hip arthroplasty (THA) for hip osteoarthritis (OA), providing a quantitative reference for direction-specific reaming patterns. In this CT-based simulation analysis, preoperative CT data from 118 female hips that underwent primary THA for primary OA or mild developmental dysplasia of the hip (DDH) between 2021 and 2024 were used to simulate cup placement at the true acetabulum. The pelvis was oriented to the functional pelvic plane, and the cup was positioned at 20° anteversion and 40° inclination. The simulated reamed area was quantified at 12 clock-face positions. Simulated reamed areas were compared by diagnosis using Holm-adjusted Student's t tests and among positions using repeated-measures ANOVA with Holm adjustment. The mean simulated reamed area was smallest at 1 o'clock (64 ± 45 mm2) and largest at 8 o'clock (137 ± 73 mm2) (p < 0.001). Post hoc comparisons showed larger reamed areas at 8 and 9 o'clock and smaller areas from 0 to 2 o'clock than at most other positions (p < 0.05). This posteriorly concentrated pattern was particularly evident in mild DDH, with smaller reamed areas from 0 to 2 o'clock and larger areas at 8 and 9 o'clock than at other positions. In this CT-based simulation study, simulated acetabular reaming was minimal in the anterosuperior region and greater posteriorly. These findings may provide anatomical information for understanding direction-specific reaming patterns, particularly in mild DDH.
ObjectivePediatric head trauma is common, but computed tomography exposes children to ionizing radiation. This systematic review and meta-analysis evaluated the diagnostic accuracy of point-of-care ultrasound for pediatric skull fractures and clarified its role as an adjunct to clinical assessment rather than a replacement for computed tomography when intracranial injury is suspected.MethodsWe conducted a systematic review and bivariate random-effects diagnostic test meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in the International Prospective Register of Systematic Reviews (Registration Number: CRD420251139217). PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 3 September 2025. Two reviewers independently screened studies, extracted 2 × 2 diagnostic data, and assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsNine studies conducted in emergency department settings met the inclusion criteria. Point-of-care ultrasound demonstrated a pooled sensitivity of 0.90 (95% confidence interval: 0.84-0.94), specificity of 0.98 (95% confidence interval: 0.94-0.99), and an area under the summary receiver operating characteristic curve of 0.96 (95% confidence interval: 0.94-0.97). The summary positive likelihood ratio was 41.73 (95% confidence interval: 15.85-109.87), and the negative likelihood ratio was 0.10 (95% confidence interval: 0.07-0.17). Deeks' funnel plot showed no evidence of small-study effects (P = 0.80).ConclusionsPoint-of-care ultrasound shows high diagnostic accuracy for detecting pediatric skull fractures and may support bedside risk stratification in selected children with low- or intermediate-risk mild head trauma. However, most isolated linear skull fractures are managed conservatively, and point-of-care ultrasound does not evaluate intracranial injury. Computed tomography decisions should therefore remain anchored in neurological status, injury mechanism, validated pediatric head injury decision rules, and clinician judgment.
ObjectiveThe study aimed to evaluate the short-term changes in central retinal thickness after uncomplicated cataract surgery in diabetic patients and assess the influence of diabetic retinopathy severity on postoperative retinal response.MethodsIn total, 102 eyes of 102 type 2 diabetic patients undergoing cataract surgery were divided into two groups: Group I (n = 51) comprised eyes without diabetic retinopathy and Group II (n = 51) included eyes with diabetic retinopathy. Central retinal thickness was assessed at baseline and postoperative weeks 1, 6, and 12 using spectral-domain optical coherence tomography. Changes in central retinal thickness of ≥10, ≥29, and ≥50 µm were analyzed.ResultsCentral retinal thickness significantly increased at 6 weeks postoperatively (Group I: median 263 µm; Group II: median 270 µm; p = 0.001). No significant differences in best-corrected visual acuity loss were observed between the two groups (p = 0.265). In Group II, the increase in central retinal thickness was highest in patients with severe diabetic retinopathy.ConclusionThe severity of diabetic retinopathy is correlated with the magnitude of retinal thickening, peaking at 6 weeks postoperatively. Despite an increase in the central retinal thickness, visual acuity remained stable during the study period. Duration of diabetes and elevated glycosylated hemoglobin levels were identified as systemic risk factors. These findings underscore the importance of optical coherence tomography-based monitoring and diabetic retinopathy staging in perioperative diabetic care.
Successful total knee arthroplasty relies on precise joint line restoration, but anatomical variations and bone loss complicate this intraoperatively. This study aimed to develop computed tomography (CT)-based estimates of the medial and lateral femoral joint lines in extension and flexion using three-dimensional imaging. Using a Computed Tomography database, the medial and lateral joint lines in extension and in flexion relative to the medial and lateral epicondyles were analysed in 724 nondegenerative femora. Linear regression models were developed using femoral width as the predictor. Independent validation was performed in 264 femora, not included in the regression analyses, to analyze prediction accuracy. The linear regression models predicted the medial and lateral extension joint lines with an R² of 70.1% and 73.0%, respectively. Similarly, R² values of 48.8% and 52.6% were obtained for the medial and lateral flexion joint lines. Validation of the models resulted in joint line prediction both in extension and in flexion, with an average error from 0 to 0.3 mm, and the 95% confidence intervals ranged up to approximately ±3 mm. This study presents CT-based regression models that characterise native femoral joint line anatomy using a large cohort of nondegenerative femora. By defining reproducible relationships between femoral geometry and joint line position, the proposed approach provides imaging-derived reference values that may support preoperative planning and joint line estimation. These findings contribute to a more detailed anatomical understanding of joint line morphology and offer a quantitative framework that could be integrated into image-based planning workflows, although clinical validation is still required. Level IV.
A dual imaging pattern of hyperattenuation on non-enhanced computed tomography and hypointensity on T2-weighted imaging is frequently encountered in various lesions. In the present review, we aimed to explore this imaging combination across a spectrum of abdominal and pelvic lesions to clarify its clinical implications.This pattern is commonly observed in lesions rich in fibrous or smooth muscle components, making it more frequently encountered in benign entities, including fat-poor angiomyolipomas, uterine leiomyomas, and tumors with predominant fibrous stroma. However, similar imaging findings may also be encountered in rare high-cellularity malignancies, selected systemic diseases, and lesions containing melanin, metal deposition, or thyroid tissue. Although not specific to a single disease, this imaging pattern offers valuable diagnostic clues for lesion characterization. When contrast-enhanced imaging is unavailable or contraindicated, combining non-enhanced computed tomography and T2-weighted imaging findings may help narrow the differential diagnosis. Despite its general association with benign lesions, this imaging phenotype requires careful exclusion of important pathologic mimics. Overall, integration with clinical information and other imaging findings remains essential for accurate interpretation.
Although exercise is recommended for cancer patients, its acute effects on tumour blood flow (TBF) have not been quantified in humans. As TBF may influence tumour progression and treatment efficacy, we assessed its circulatory responses in malignant lymphoma during exercise using dynamic PET imaging. Patient/material and methods: Eight patients with Hodgkin or non-Hodgkin lymphoma underwent thoracic [¹⁵O]H₂O positron emission tomography/computed tomography (PET/CT) at rest and during 10 min of supine cycling (Borg RPE 11-16). TBF and its heterogeneity, tumour blood volume (TBV), mean transit time (MTT), and vascular resistance were quantified in eight index and three secondary tumours. Baseline TBF in index tumours was high (mean 57.6 mL/dL/min; range 30.3-105.0). During exercise, TBF (mean 48.1 ± 16.1 mL/dL/min), its heterogeneity and MTT did not change significantly. However, TBV decreased (p = 0.038), and vascular resistance tended to increase (p = 0.055). TBF change correlated positively with age (r = 0.73, p = 0.04) and negatively with tumour volume (r = -0.67, p = 0.02), but not with heart rate or power output. Secondary tumours showed similar exercise responses, with lower absolute TBF (p = 0.02). This study demonstrates the feasibility of using [¹⁵O]H₂O PET/CT to quantify TBF in lymphoma patients in real time during acute exercise. Baseline TBF is remarkably high in lymphoma tumours, and responses to acute exercise are variable, tending to decline in younger patients and larger tumours, while vascular resistance tended to increase.
Left ventricular pseudoaneurysm (LVP) is considered a surgical emergency; however, diagnosis is often delayed owing to its often-insidious presentation. We present a case of a patient with non-specific symptoms who was found to have a massive LVP. Retrospective review of a transthoracic echocardiogram (TTE) and single photon emission computed tomography (SPECT) with computed tomography (CT) attenuation correction 2 years before this presentation demonstrates a similarly sized LVP that was initially undetected, as it mimicked normal anatomy. Common, readily available testing after myocardial infarction, such as TTE and SPECT with CT attenuation correction, are not traditionally utilized for LVP diagnosis because of their low sensitivity. This case demonstrates that these tests may serve a complementary role, providing an opportunity to quickly detect abnormalities and expedite definitive testing. However, cognizance of at-risk patients by cardiac imagers is paramount to increase detection.
Mild traumatic brain injuries (mTBI) affect millions of people worldwide every year as one of the most common clinical presentations in the emergency department. Diagnosis is mainly based on clinical criteria and computed tomography scans. The use of computed tomography causes high costs, long waiting times in daily clinical practice and radiation exposure. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) turned out to be potential biomarkers for the diagnosis of mTBI. This study retrospectively evaluates the possible use of these biomarkers combined as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department. Adult patients (n = 320) registered in the emergency department at a level 1 trauma emergency center in Germany (Cologne Merheim Medical Center/CMMC) between 11/2023 and 04/2024, with suspected mTBI, Glasgow Coma Scale (GCS) score 13-15 and within 12 h after trauma were considered. All evaluable patients underwent cranial CT (cCT) scans and blood tests for GFAP and UCH-L1 serum concentrations. Biomarkers GFAP and UCH-L1 were tested positive in 261 patients (82%) while CT detected intracranial injuries in only 29 patients (9%). Biomarkers combined had a sensitivity of 97% and a negative predictive value (NPV) of 98% in mTBI diagnosis with a negative CT scan. The biomarkers GFAP and UCH-L1 combined could play a potential clinical role in avoiding unnecessary cCT scans in emergency departments after mTBI, might reduce treatment times and reduce radiation exposure.
The pectoralis major (PM) muscle is commonly used in reconstruction because of its robust vascular supply from the thoracoacromial artery, although vascular dominance varies among individuals. Transcatheter arterial embolization is effective for hemostasis but may risk ischemia when a dominant pedicle is compromised. We describe a case of delayed PM muscle necrosis after selective arterial embolization for traumatic chest wall hemorrhage. A 76-year-old man with diabetes mellitus, pancreatic head carcinoma under chemotherapy, and polymyalgia rheumatica treated with prednisolone for a prolonged period (7 mg/d) developed acute right chest pain after lifting approximately 30 kg of hay. Computed tomography showed a large subcutaneous and subpectoral hematoma (123.9 × 115.7 × 66.0 mm) without extravasation. On day 10, computed tomography demonstrated active bleeding from branches of the thoracoacromial artery and lateral thoracic artery. Selective embolization of 1 branch of each artery was performed using a 1:3 mixture of N-butyl-2-cyanoacrylate (Histoacryl, B. Braun, Melsungen, Germany) and Lipiodol (Lipiodol, Guerbet, Villepinte, France), without coil embolization. Several weeks later, wound breakdown occurred; operative exploration revealed extensive PM muscle necrosis. Debridement and negative-pressure wound therapy were followed by delayed primary closure on day 113, with complete healing at 6 months. Selective embolization of branches supplying the PM muscle can rarely result in severe muscle necrosis, particularly in patients with reduced ischemic tolerance. Awareness, surveillance for delayed deep ischemia, and staged reconstruction are essential.
Acute pulmonary thromboembolism is a serious complication of total hip arthroplasty that may be asymptomatic, underscoring the importance of early detection. Contrast-enhanced computed tomography is the standard diagnostic modality; however, its use is limited by its invasiveness, radiation exposure, contrast allergy, and renal dysfunction. Dynamic digital radiography is a novel, minimally invasive imaging technique that enables visualization of pulmonary perfusion without contrast agents. We report a case of a 58-year-old woman who underwent primary total hip arthroplasty. Post-operatively, the patient remained asymptomatic. One week after total hip arthroplasty, follow-up dynamic digital radiography demonstrated newly developed pulmonary perfusion abnormalities, with marked signal reduction in the right middle and lower lung zones, and a mild reduction in the left upper lung zone. Subsequent contrast-enhanced computed tomography confirmed bilateral pulmonary thromboembolism corresponding to perfusion defects detected using dynamic digital radiography. Anticoagulant therapy completely resolved the thromboembolism. This case highlights the potential utility of dynamic digital radiography for early detection of asymptomatic acute pulmonary thromboembolism following total hip arthroplasty.
Cor-triatriatum sinistrum (CTS) is a rare congenital heart disease, characterized by a membrane dividing the left atrium into two chambers. Echocardiography is the primary imaging modality. However, computed tomography and magnetic resonance imaging both play important roles in delineating the anatomy of the condition and also determining the associated anomalies. Although thought to be a disease of childhood, CTS can also present in adulthood with varied clinical manifestations like dyspnea, palpitations, and syncopal attacks. In CTS, the left atrial membrane causes pulmonary venous obstruction and eventual pulmonary arterial hypertension. It is usually associated with membrane fenestrations, which allow some antegrade flow. If not, there are relief valves, such as the ostium secundum atrial septal defect (OS-ASD) and/or the levo-atrial-cardinal vein. We present three patients with CTS. The first patient is of Type I CTS-presenting with CTS and an OS-ASD, which is acting as a relief valve. The second patient is of Type II CTS with associated levo-atrio-cardinal vein and venovenous shunting. The third patient presented with CTS with partial anomalous pulmonary venous connection (PAPVC)-suggestive of Type III CTS. All the cases were managed surgically with good outcomes. CTS, though thought to be a disease of childhood, may present in adults with varied clinical presentations. Imaging plays a crucial role in the diagnosis and delineation of associated anomalies. Management is usually surgical with a good clinical outcome.
Hepatocellular carcinoma (HCC) predominantly arises against a background of chronic liver disease and cirrhosis, with its development typically following the three-step pattern of "hepatitis-cirrhosis-liver cancer." Hepatocellular carcinoma precursor lesions represent a critical stage in this process and constitute a vital window for early diagnosis and targeted intervention. This review aims to systematically summarize the pathological basis, malignant potential, diagnostic approaches, risk stratification strategies, and precision intervention perspectives of HCC precursor lesions. Specifically, we review the pathological characteristics and malignant potential of HCC precursor lesions such as hepatocellular large/small cell transformation, dysplastic foci (DF), low/high-grade dysplastic nodules (LGDN/HGDN), and β-catenin-activated hepatocellular adenoma. We further summarize the application value and limitations of ultrasound/contrast-enhanced ultrasound (US), computed tomography (CT), and Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in screening and differential diagnosis. In addition, we discuss the progress in serum markers such as AFP, AFP-L3, DCP, and GP73, as well as liquid biopsy markers including CTC, ctDNA methylation, cfRNA, and tumor metabolites. We also outline the application of multivariable risk models like age-Male-ALBI-Platelet (aMAP), Gender-Age-AFP-L3-AFP-DCP (GALAD), and THRI in risk stratification and dynamic monitoring of high-risk populations. Finally, we review current treatment and follow-up strategies for HCC precursor lesions and explore the potential of radiomics, artificial intelligence, and multi-omics integration to improve risk assessment and diagnostic support, while also discussing their current limitations and the gap between research findings and routine clinical implementation. Overall, HCC precursor lesions represent an important target for early surveillance and precise intervention, and the integrated application of pathology, imaging, biomarkers, risk models, and emerging technologies may improve early identification, individualized management, and future translational research in HCC.
ObjectiveTo evaluate 3-dimensional pharyngeal airway changes following 2-jaw orthognathic surgery in skeletal Class III patients and to assess their association with surgical movements.DesignRetrospective observational study.SettingSingle tertiary care center.PatientsTwenty-seven adult patients with skeletal Class III malocclusion who underwent Le Fort I maxillary advancement combined with bilateral sagittal split osteotomy mandibular setback.InterventionsAll patients received 2-jaw orthognathic surgery with preoperative (T0) and postoperative (T1, 6 months) computed tomography imaging.Main Outcome MeasuresThree-dimensional airway volumes of the nasopharynx, oropharynx, and hypopharynx were measured. Correlations between airway volume changes and skeletal movements were analyzed.ResultsSignificant regional differences in airway changes were observed. The nasopharyngeal airway volume increased (+1979.1 mm3), while the oropharyngeal airway showed minimal change (+336.4 mm3). In contrast, the hypopharyngeal airway demonstrated a significant reduction (-1087.5 mm3). A strong correlation was found between mandibular setback and hypopharyngeal airway reduction at Point B (r = 0.73, P = .023).ConclusionsTwo-jaw orthognathic surgery results in region-specific airway changes. Hypopharyngeal airway reduction is associated with mandibular setback, while maxillary advancement contributes to upper airway enlargement. These findings reflect morphological rather than functional changes, and further studies incorporating functional assessments are required to determine their clinical significance.