The aim of this study was to evaluate the performance of the ChatGPT-o1-preview language model in solving the Polish National Specialization Exam (PES) in radiology and imaging diagnostics and compare its results with previous versions of the model. A set of 119 valid radiology exam questions from Spring 2023 was analyzed. Each question was classified by type, subtype, and clinical relevance. ChatGPT answered each question five times using a standardized prompt with a 5-point confidence scale. Performance was assessed using accuracy and declared and calculated difficulty indices. Statistical analysis was performed in Python with a significance level of p < 0.05, and results were compared with a previous model version. The model achieved a score of 93.33% correct answers, comparable to the average physician score of 94.86%. ChatGPT-o1-preview showed exceptional accuracy in "memory" questions, with over 96% correct answers. This result, significantly higher than that of the older ChatGPT-3.5 model (52%), demonstrates progress in artificial intelligence (AI) capabilities. The model also exhibited higher confidence in its responses, indicating better adaptation to medical exams. Despite its high accuracy, the study was based on a relatively small set of questions, which limits the ability to fully assess the model's effectiveness. The results indicate the potential of AI as a tool to support clinical work, but further, more extensive research is necessary to evaluate its applicability and reliability in the medical environment.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
To compare the effectiveness of time-of-flight (TOF) magnetic resonance angiography (MRA) and magnetic resonance (MR) vessel wall imaging (VWI) in assessing the degree of vascular involvement in patients with moyamoya disease (MMD). This was a single-time observational study carried out on patients with MMD before any surgical interventions. In addition to routine magnetic resonance imaging sequences, TOF MRA and VWI were performed. A total of 11 vascular segments (bilateral supraclinoid and terminal internal carotid arteries [ICA], anterior cerebral arteries [ACA], middle cerebral arteries [MCA], posterior cerebral arteries [PCA], and the distal basilar artery) were assessed in each patient for steno-occlusive changes on TOF MRA, and the presence of vessel wall thickening and enhancement on high-resolution VWI. Comparative analysis between the TOF MRA and VWI findings was conducted. A total of 40 cases were included, out of which 39 patients presented with infarcts, predominantly in multiterritorial distribution and only one patient presented with intracerebral hemorrhage. 440 vascular segments were assessed on TOF MRA and VWI, out of which TOF MRA revealed 38.8% stenotic (n = 171) and 30.2% (n = 133) occluded vascular segments. VWI revealed concentric vessel wall thickening in 97.5% of cases, with vessel wall contrast enhancement detected in 306 segments (69.54%). On comparison of TOF MRA and VWI findings, 69.09% of segments were abnormal on TOF MRA, while VWI detected 81.4% abnormal segments; notably, 11.8% of segments labeled normal on TOF MRA exhibited abnormal vessel wall traits on VWI. This study highlights the valuable role of VWI as an important diagnostic tool and its superiority to TOF MRA for evaluating the extent of vascular involvement in patients with MMD.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Artificial intelligence (AI) is playing an increasingly important role in diagnostic imaging, helping specialists improve the quality and speed of medical services. Despite the potential of AI, electroradiologists express concerns about algorithm errors, overreliance on technology, and ethical issues. Further training of medical personnel is necessary to ensure the safe and informed implementation of AI in diagnostics. This study examines the use of AI tools as perceived by radiographers, focusing on their impact on work organization. The work was carried out using a diagnostic survey method in the form of questionnaires. The survey was conducted in the second quarter of 2025. The analysis used both descriptive statistics and statistical tests to assess the significance of differences and relationships between variables. Descriptive statistics analyzed quantitative variables. Statistical calculations were based on the χ2 test. A significance level of p < 0.05 was adopted. In analyses considering respondents' age, age groups were categorized accordingly. The study involved 202 professionally active electroradiologists (working in diagnostic imaging and interventional radiology) - 166 women (82.18%) and 36 men (17.82%), with an average age of 31.75 years. Analyses showed no statistical correlation between education, age, work experience, and level of knowledge about AI. However, correlations appeared in the implementation of these tools across medical facilities and their use in radiographers' work. In-depth analyses revealed a positive attitude toward AI tools but also highlighted insufficient education and the need for training. Most electroradiologists are familiar with the general concept of AI, but lack detailed knowledge, indicating a need for targeted education. Despite a positive attitude towards AI, a lack of training limits readiness for its implementation. Age and workplace influence the perception of AI, while education, gender, and seniority remain insignificant. The key barriers are competency- and organization-related, highlighting the need for consistent educational programs. Med Pr Work Health Saf. 2026;77(2):147-161. Sztuczna inteligencja (artificial intelligence – AI) odgrywa coraz większą rolę w diagnostyce obrazowej, wspierając specjalistów w poprawie jakości i szybkości usług medycznych. Mimo potencjału AI elektroradiolodzy wyrażają obawy dotyczące błędów algorytmów, nadmiernego polegania na technologii i kwestii etycznych. Konieczne jest dalsze kształcenie personelu medycznego, aby zapewnić bezpieczne i świadome wdrażanie AI w diagnostyce. Celem niniejszego badania jest analiza zastosowania narzędzi AI w percepcji elektroradiologów, ze szczególnym uwzględnieniem ich wpływu na organizację pracy w tym zawodzie. Pracę zrealizowano metodą sondażu diagnostycznego w formie badań ankietowych w II kwartale 2025 r. W analizie wykorzystano zarówno statystyki opisowe, jak i testy statystyczne, umożliwiające ocenę istotności różnic i zależności pomiędzy zmiennymi. W celu analizy zmiennych ilościowych przeprowadzono statystyki opisowe. Obliczenia statystyczne opierały się na teście χ2. Jako poziom istotności przyjęto p < 0,05. W analizach uwzględniających wiek respondentów przedziały wiekowe zostały wcześniej odpowiednio skategoryzowane. W badaniu wzięło udział 202 aktywnych zawodowo elektroradiologów (pracujących w diagnostyce obrazowej i radiologii zabiegowej), w tym 166 kobiet (82,18%) i 36 mężczyzn (17,82%). Średni wiek badanych wyniósł 31,75 roku. W analizach nie wykazano zależności statystycznych pomiędzy wykształceniem, wiekiem, stażem pracy a poziomem wiedzy nt. zagadnień związanych z AI. Zależności występowały w przypadku implementacji w różnych placówkach medycznych oraz w związku z wykorzystaniem tych narzędzi w pracy elektroradiologów. W pogłębionych analizach badani wykazywali pozytywne nastawienie do narzędzi AI, ale jednocześnie wyniki wskazywały na niedostateczną edukację w tym zakresie i potrzebę szkoleń. Większość elektroradiologów zna ogólne pojęcie AI, jednak brakuje im wiedzy szczegółowej, co wskazuje na potrzebę ukierunkowanego kształcenia. Mimo pozytywnego nastawienia wobec AI niedobór szkoleń ogranicza gotowość do jej wdrażania. Wiek i miejsce pracy wpływają na percepcję AI, podczas gdy wykształcenie, płeć i staż pracy pozostają bez istotnego znaczenia. Główne bariery mają charakter kompetencyjny i organizacyjny, co podkreśla konieczność wprowadzenia spójnych programów edukacyjnych. Med Pr Work Health Saf. 2026;77(2):147–161.
To study the diagnostic role of contrast-enhanced ultrasound (CEUS) in terms of sensitivity, specificity, and its comparison with grey-scale ultrasound with colour Doppler in characterising malignant breast masses. An observational study was done for duration of 18 months, including 64 adult females with breast masses. Patients underwent various investigations in the form of conventional ultrasound with colour Doppler and CEUS. Patients underwent surgery, and a histopathological examination was performed on a surgical specimen for confirmation of a benign or malignant lesion. Outcome measures were the proportion of benign and malignant lesions of the breast and the diagnostic accuracy of CEUS in characterising malignant lesions in the breast. On analysis, CEUS showed very good agreement with histopathological diagnosis with κ 0.967 (p < 0.0001); while good agreement was found between histopathological diagnosis and diagnosis by B mode + colour Doppler with κ 0.772 (p < 0.0001). CEUS demonstrated sensitivity of 100%, specificity of 96.15%, and AUC of 0.98, while diagnosis B mode + colour Doppler yielded sensitivity of 92.11%, specificity of 84.62%, and diagnostic accuracy of 89.06%. CEUS was found to have a better diagnostic accuracy for differentiation of benign and malignant breast masses (using histopathology as a gold standard). The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CEUS was found to be 99%, 96%, 97.4%, 99%, and 98.4% respectively.
Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF. In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than -1, underweight was defined as weight-for-age Z scores (WAZ) less than -1, and wasting was defined as weight-for-height Z scores (WHZ) less than -1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than -1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations. All estimates were age-specific, sex-specific, geography-specific, and year-specific. We estimated that, in children younger than 5 years in 2023, CGF was associated with 79·4 million (95% uncertainty interval [UI] 47·0-106) DALYs lost and 880 000 (517 000-1 170 000) deaths. This represented 17·9% (10·6-23·8) of 444 million (434-457) total under-5 DALYs and 18·8% (11·1-25·0) of all 4·67 million (4·59-4·75) under-5 deaths. Compared to stunting (33·0 million [24·1-42·2] DALYs, 373 000 [272 000-477 000] deaths) and wasting (39·2 million [23·8-53·0] DALYs, 428 000 [256 000-583 000] deaths), childhood underweight was associated with the largest share of CGF-related disease burden: 52·2 million (21·9-75·1) DALYs and 573 000 (236 000-824 000) deaths in children younger than 5 years in 2023. CGF remains a leading factor associated with death and disability in children younger than 5 years, despite global attention and focused interventions to reduce the prevalence of associated CGF indicators. Our findings underscore the need for policies, strategies, and interventions that focus on all indicators of CGF to reduce its associated health burden. Gates Foundation.
Chronic kidney disease (CKD) is common and ranks among the leading causes of mortality and morbidity. This analysis aimed to present global CKD estimates using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to inform evidence-based policies for CKD identification and treatment. This analysis focused on adults aged 20 years and older over the period 1990 to 2023, from 204 countries and territories. Data sources used were published literature, vital registration systems, kidney failure treatment registries, and household surveys. Estimates of CKD burden, including deaths, incidence, prevalence, and disability-adjusted life-years (DALYs), were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool. A comparative risk assessment approach estimated the proportion of cardiovascular deaths attributable to impaired kidney function and estimated risk factors for CKD. Globally, in 2023, 788 million (95% uncertainty interval 743-843) people aged 20 years and older were estimated to have CKD, up from 378 million (354-407) in 1990. The global age-standardised prevalence of CKD in adults was 14·2% (13·4-15·2), a relative rise of 3·5% (2·7-4·1) from 1990. The region with the highest age-standardised prevalence was north Africa and the Middle East (18·0%; 16·9-19·4). Most people had stage 1-3 CKD, with a combined prevalence of 13·9% (13·1-15·0). In 2023, CKD was the ninth leading cause of death globally, accounting for 1·48 million (1·30-1·65) deaths, and the 12th leading cause of DALYs, with an age-standardised DALY rate of 769·2 (691·8-857·4) per 100 000. Impaired kidney function as a risk factor accounted for 11·5% (8·4-14·5) of cardiovascular deaths. High fasting plasma glucose, body-mass index, and systolic blood pressure were all leading risk factors for CKD DALYs. CKD is a major global health issue, with rising prevalence and increasing importance as a cause of death and as a risk factor for cardiovascular death. A better understating of aetiology, appropriate screening, and implementation programmes are needed to translate advances in CKD treatment into improved patient outcomes. Gates Foundation, Wellcome, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.
To investigate the role of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the prediction of histological differentiation and local invasion (T stage) of rectal non-mucinous adenocarcinoma for appropriate treatment planning. Pre-operative magnetic resonance imaging (MRI) and IVIM-DWI examinations were prospectively performed in patients with rectal non-mucinous adenocarcinoma. A total of 36 patients with a mean age of 61 ± 8 years (range: 26-85 years) were included. Size, signal intensities and enhancement pattern of tumors, lymphadenopathy, serosal involvement, adjacent organ invasion, and metastasis were noted. IVIM-DWI parameters were estimated. Relationships between IVIM-DWI parameters and histopathological results were analyzed using Mann-Whitney U and Kruskal-Wallis tests. Receiver operating characteristic analysis was performed for optimal cut-off values. In our study, a total of 36 patients were enrolled. There was a negative relationship between tumor differentiation and perfusion (f) (p < 0.05). A negative relationship was detected between T staging and true diffusion (D), pseudo-diffusion coefficient (D*) and apparent diffusion coefficient (ADC) values (p < 0.05). Lower D, D*, and ADC values were detected in late stage (T3-T4) rectal tumors and nodal metastasis (p < 0.05). Lower f values were achieved in higher histological grades (p < 0.05). In differentiation of poorly from well- and moderately differentiated tumors, cut-off value of < 20.89 showed 88.5% sensitivity and 85.7% specificity (area under the curve: 0.771, p < 0.05). Aggressive tumors with low histological differentiation and metastatic lymphadenopathy exhibit lower diffusion and perfusion values. As a perfusion indicator, f provides valuable information regarding tumor differentiation. IVIM-DWI can be used as an adjunctive modality to routine abdominal MRI in the local staging of rectal carcinoma.
Laryngeal squamous cell carcinoma (LSCC) is a malignancy with significant morbidity and mortality. Accurate preoperative assessment of key histopathological features, including lymph node metastasis (LNM), extranodal extension (ENE), lymphovascular invasion (LVI), perineural invasion (PNI), and thyroid cartilage invasion (TCI), is crucial for optimising treatment strategies. Computed tomography (CT)-based texture analysis, a radiomics approach, has shown potential in identifying tumour heterogeneity and aggressive histopathological behaviour. The aim of the study was to evaluate the predictive value of CT-based texture analysis for detecting key histopathological features in LSCC and assess its potential as a non-invasive tool for preoperative risk stratification. This retrospective study included 32 LSCC patients who underwent contrast-enhanced neck CT within 4 weeks before surgery. Texture features were extracted using LIFEx software. Mann-Whitney U tests and receiver operating characteristic (ROC) curve analyses were performed to assess diagnostic performance. Significant texture features were identified for LNM, ENE, and TCI (p < 0.05). GLZLM_HGZE ≤ 4635 predicted LNM with an AUC of 0.847 (95% CI: 0.708-0.986), sensitivity of 71%, and specificity of 84%. For ENE, GLZLM_HGZE ≤ 4625 achieved an AUC of 0.891, sensitivity of 85%, and specificity of 84%. TCI prediction was highest with GLZLM_SZLGE ≥ 0.00118 (AUC: 0.964, 95% CI: 0.909-1.000), with sensitivity of 88% and specificity of 93%. No significant predictors were found for LVI or PNI. CT-based texture analysis is a promising non-invasive tool for preoperative risk assessment in LSCC, particularly for LNM, ENE, and TCI. Further validation in larger studies is warranted.
Hemorrhagic transformation (HT) represents a serious complication in the management of acute ischemic stroke (AIS), particularly following endovascular treatment (EVT). While clinical predictors of HT have been widely studied, the prognostic value of imaging-based collateral scoring systems remains less well defined. The main purpose of the study is to evaluate the prognostic accuracy of four commonly used collateral scoring systems - Miteff, Maas, modified Tan, the Alberta Stroke Program Early CT Score - and combinations of them, with established variables for predicting HT in AIS patients treated with EVT beyond the 4.5-hour window. This retrospective single-center study included 162 AIS patients who underwent EVT between 2017 and 2023. Patients with baseline computed tomography angiography and follow-up computed tomography were included; those receiving thrombolysis were excluded. Collateral status was assessed using four scoring systems. HT was confirmed by imaging. Patients were divided into HT and non-HT groups. Statistical analysis included χ2 tests, binary logistic regression, and ROC curve analysis and evaluation of predictive models (Collateral Model and Integrated Clinical-Collateral Model). Significance was set at p < 0.05. None of the individual collateral scoring systems reached statistical significance as independent predictors of HT. The Collateral Model achieved an area under the curve (AUC) of 0.837 (95% confidence interval [CI]: 0.769-0.906), indicating acceptable discrimination. The Integrated Clinical-Collateral Model further improved predictive performance, with an AUC of 0.933 (95% CI: 0.883-0.983), reflecting excellent accuracy. While individual collateral scoring systems showed limited value in predicting HT risk, their combined use improved prognostic accuracy. The predictive accuracy was even better when collateral scores were integrated with established clinical and imaging predictors.
Anomalous aortic origin of a coronary artery (AAOCA) is a congenital cardiac anomaly in which a coronary artery arises from an abnormal location on the aorta. In this article, we refer to the classification by Cheezum et al. [1], which distinguishes anomalies according to the point of origin and the course of the abnormal artery. The study aimed to determine the frequency of occurrence of anomalies and to assess types associated with an increased risk of sudden cardiac death. We retrospectively analyzed 16,680 electrocardiography-gated cardiac computed tomography (CT) scans from years 2015-2022. Anomalies were found in 102 patients. Inclusion criteria were: scan description allowing for identification of coronary anomalies or images available, and patient age over 18 years. This resulted in a sample of 96 patients with anomalies. The study group consisted of 42 women and 54 men; median age at the time of diagnosis was 61 years. The most common anomalies were: right anomalous origin of the left circumflex artery (R-LCx) (48 cases - 50%), right coronary artery from the left sinus (17 cases - 18%), left main coronary artery from the right sinus (7 cases - 7%), and left anterior descending artery from the right sinus (12 cases - 13%). The courses were as follows: retroaortic (47 cases - 48%), interarterial (27 cases - 29%), retrocardiac (2 cases - 2%), and prepulmonic (2 cases - 2%). AAOCAs were found in 0.58% of CT scans performed. R-LCx was the most prevalent type, and the most prevalent course was retroaortic (47). Anomalies were mostly benign in their clinical manifestations.
Coronary artery disease (CAD) remains a leading cause of disability and death worldwide. Noninvasive tests are crucial to ensure early diagnosis and risk stratification. The coronary artery calcium scoring (CACS), a non-invasive measure obtained using non-contrast computed tomography, reflects the calcific plaque burden, and may provide important diagnostic and prognostic information. This study aimed to systematically review and meta-analyze the recent literature to ascertain the diagnostic and prognostic usefulness of CACS in patients with suspected or established CAD. A literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2008 and 2024. The studies were included if they evaluated the prognostic and diagnostic value of CACS, either alone or with computed tomography angiography (CTA). Data extraction was performed for pooled sensitivities and specificities, hazard ratios (HRs), and event-free survival. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria were used to assess methodological quality. Fourteen high-quality studies with a total of more than 80,000 patients were meta-analyzed. Subjects with CAC ≥ 100 were at a significantly increased risk of developing major adverse cardiac events (HR 2.7; 95% confidence interval: 2.1-3.6). CACS is highly beneficial in diagnostic discrimination (pooled sensitivity 88%, specificity 77%) in those presenting with chest pain but no prior history of CAD. It is essential to emphasize that CAC score of zero correlates with the best prognosis and very low rates of clinical events across various populations, including patients with diabetes and asymptomatic individuals. The CACS fills a special niche as a very strong predictor and non-invasive marker in the diagnosis and prognosis of CAD. Combining calcium scoring with CTA benefits clinical decision-making, particularly for patients categorized as low to intermediate risk.
Early detection is critical in pancreatic ductal adenocarcinoma (PDAC)-one of the most lethal malignancies due to its typically late diagnosis. In this study, we aimed to validate an epidemiological risk score (ERS) designed to identify individuals at increased risk of developing PDAC prior to the use of imaging or other diagnostic procedures. The ERS was constructed through a meta-analysis of 24 well-established epidemiological risk factors. We applied this score to a prospective cohort of 178 high-risk individuals with a family history of PDAC within the IMAGene project (ClinicalTrials.gov registration code: NCT06334458). To evaluate the predictive value of the ERS, all participants underwent whole-body or abdominal magnetic resonance imaging (MRI) and the findings were classified according to the Oncologically Relevant Findings Reporting and Data System criteria to identify and categorize lesions based on their malignant potential. External validation was conducted by using a subset of the UK Biobank (UKB) cohort (≈300 000 individuals), among whom 1648 were diagnosed with PDAC. Higher ERS values were associated with the presence of potentially malignant lesions on MRI. Both pancreatic and extra-pancreatic malignant lesions were more frequent among individuals with higher ERS scores (P = .01 and P = .02 respectively) compared with controls. External validation in PDAC cases within the UKB cohort confirmed these associations. Our findings support the integration of the ERS as a feasible, low-cost tool for PDAC risk stratification, with the potential to facilitate earlier detection and improve clinical outcomes.
The aim of this study was to characterize the distribution of coronary plaque burden and gender differences in the estimated age of coronary artery calcium (CAC) initiation in patients with moderate or low probability of coronary artery disease using cardiac computed tomography imaging. CAC was measured using the Agatston method. The patients were categorized into risk categories based on CAC score (CACs) and based on the number of involved coronary vessels. We investigated CAC distribution and plaque burden throughout the coronary vasculature in both sexes. Furthermore, we calculated the calcification initiation in each main coronary artery territory, assuming that average annual CACs progression is 25% per year. Among the 937 affected vessels, calcifications were most prevalent in the left anterior descending artery (LAD), with a higher plaque burden ratio. Among patients with a low CAC burden, the LAD was the most frequently involved vessel. Analysis of the estimated age of CAC initiation reveals that calcification begins to develop earlier in the LAD than in other coronary territories in both sexes. Involvement of the second coronary artery territory after one-vessel disease can be expected after a median of 4.5 years (range 2.2-8), with no significant difference between men and women. Calcified plaque was most commonly identified in the LAD. CAC occurs earlier in the LAD than in other coronary arteries. The particular susceptibility to calcification of LAD is not related to gender.
Secondary haemochromatosis among paediatric oncologic patients is associated with various long-term complications. The liver is the most important organ for assessment of iron overload because the iron concentration is linearly correlated with total body iron stores. In the paediatric population, liver biopsy is considered too invasive for routine use. Therefore, evaluation of iron overload with magnetic resonance imaging is an alternative method. Reliable assessment of iron burden is necessary for early detection and severity grading. In the last 2 decades multiple methods for iron quantification with magnetic resonance imaging (MRI) have been developed. Both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies, are in clinical use. However, there are no universally accepted MRI protocols for paediatric oncology patients suspected of secondary haemochromatosis. If diagnosed and treated early, haemochromatosis progression can be distinctively altered. Iron overload impacts hepatocytes, pancreas's beta cells, heart, and spleen. Each organ displays distinct patterns of iron distribution, which require targeted imaging methods. This review will address the importance of using magnetic resonance imaging for iron measurements, as well as the evaluation for the liver, pancreas, and spleen.
This study aims to compare the clinical, imaging, and pathological characteristics of benign and malignant solitary pulmonary cystic nodules, and identify key indicators associated with malignant risk and invasion depth, assisting clinicians in early detection and assessment of tumour invasiveness. This study conducted a retrospective analysis of patients with pulmonary cystic nodules who underwent surgical treatment, and it classified them into benign and malignant groups based on postoperative pathological results. We collected patients' clinical data, serum biomarkers, and CT imaging data and compared them using univariate analysis of variance. We included statistically significant indicators in a multivariate regression model to identify independent predictive factors for early malignant transformation of cystic lung cancer. Additionally, we collected the pathological types and tissue infiltration grades of the malignant group and further explored the relationship between imaging features and pathological grading by comparing the imaging characteristics corresponding to different pathological infiltration degrees, and visualised the results using a forest plot. Following multifactorial Cox analysis age, CA199, homogeneity of cyst wall thickness, cystic wall finish, number of cystic cavities, ground glass sign, and the nodule's relationship to surrounding tissues (burr, pleural indentation sign) had a significant effect on the evolution of cystic malignant nodules. Finally, in the malignant nodule group, the presence or absence of the ground glass sign was statistically significant concerning the different pathologic grades. Our multivariate predictive study indicates that certain imaging features of pulmonary cystic nodules may suggest malignant progression and are associated with different levels of pathological invasion.
The same dataset can be analysed in different justifiable ways to answer the same research question, potentially challenging the robustness of empirical science1-3. In this crowd initiative, we investigated the degree to which research findings in the social and behavioural sciences are contingent on analysts' choices. We examined a stratified random sample of 100 studies published between 2009 and 2018, in which, for one claim per study, at least five reanalysts independently reanalysed the original data. The statistical appropriateness of the reanalyses was assessed in peer evaluations, and the robustness indicators were inspected along a range of research characteristics and study designs. We found that 34% of the independent reanalyses yielded the same result (within a tolerance region of ±0.05 Cohen's d) as the original report; with a four times broader tolerance region, this indicator increased to 57%. Of the reanalyses conducted, 74% reached the same conclusion as the original investigation, 24% yielded no effects or inconclusive results and 2% reported the opposite effect. This exploratory study indicates that the common single-path analyses in social and behavioural research should not be simply assumed to be robust to alternative analyses4. Therefore, we recommend the development and use of practices to explore and communicate this neglected source of uncertainty.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.