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This study aimed to develop and evaluate a deep learning algorithm for detecting and classifying intrasinus calcifications on paranasal sinus (PNS) computed tomography (CT) for the diagnosis of fungal sinusitis and differentiation of fungal and non-fungal sinusitis. A dataset of 277 PNS CT cases from Korea University Guro Hospital, supplemented by temporal and geographic external test sets, was utilized. A 3D U-Net model was employed to segment maxillary sinus regions. YOLO v5 identified calcifications, followed by classification into three patterns: normal sinus or chronic sinusitis without calcifications, dense peripheral dystrophic calcification, and central punctate fungal calcification. A separate convolutional neural network (CNN) refined the classification to ensure accurate categorization of calcification patterns. The 3D U-Net model achieved a Dice Similarity Coefficient of 0.9674, indicating accurate segmentation. YOLO v5 demonstrated precision of 79.50% and recall of 92.14% in detecting calcifications. The CNN classification model attained F1 scores of 94.73%, 90.60%, and 94.01%, and overall accuracies of 97.48%, 86.87%, and 94.01% for internal, temporal, and geographic test sets, respectively. This study demonstrated the capability of deep learning algorithms to accurately detect and classify fungal sinusitis-related calcifications on PNS CT scans. The developed framework achieved high accuracy in segmentation of sinus area and detection/classification of intrasinus calcifications. The framework also demonstrated its potential for broader application to radiographic imaging.

Despite the increasing emphasis on interdisciplinary research in universities, we know little about the extent to which university education is interdisciplinary. This study investigates whether higher education has embraced interdisciplinarity. By applying natural language processing techniques to a dataset of 478,233 syllabi from 2004 to 2019, our analysis examines three key dimensions: lexical, topical, and pedagogical. Contrary to the prevailing narrative of growing interdisciplinarity, the findings reveal remarkable stability in the disciplinary boundaries of course content. Lexical analysis indicates minimal convergence in terminology across disciplines, while topical analysis shows consistent topic distributions within broad academic fields. Similarly, pedagogical strategies, as evidenced by the verbs used in learning objectives, display no significant shift toward interdisciplinary actions as outlined in Bloom’s taxonomy. These results suggest that despite institutional rhetoric, interdisciplinary education remains largely static, emphasizing the need for deliberate institutional strategies to better align educational practices with interdisciplinary research goals.

Objectives Although the overestimation problem of time-of-flight magnetic resonance angiography (TOF-MRA) applying the warfarin-aspirin symptomatic intracranial disease (WASID) method to assess intracranial arterial stenosis has often been suggested, no pertinent grading system for TOF-MRA has been developed. We aimed to develop and evaluate the performance of a visual grading system for intracranial arterial stenosis on TOF-MRA (MRA VICAST ). Methods This single-center cohort study analyzed prospective observational registry data from a comprehensive stroke center between January 2014 and February 2020. Patients with confirmed stenosis of the intracranial large arteries who underwent confirmative digital subtraction angiography (DSA) were included; a 4-point grading system was developed based on physical characteristics of TOF-MRA. The overall diagnostic accuracies of MRA VICAST for each grade, interobserver reproducibility, and positive predictive values for > 50% and > 70% stenoses were evaluated. Results We analyzed 132 segments with intracranial atherosclerotic stenosis from 71 patients (34 men and 37 women; mean age, 61.0 ± 15.25 years; range, 21–89 years). The overall diagnostic accuracy of MRA VICAST (93.9%, 124/132) was higher than that of MRA WASID (50.8%, 67/132) for each grade. The degree of stenosis did not differ significantly between MRA VICAST and DSA WASID ( p  = .849). Regarding reproducibility, MRA VICAST demonstrated excellent interobserver agreement (ICC, 0.989; 95% CI, 0.979–0.999). The positive predictive values of MRA VICAST for the diagnosis of > 50% and > 70% stenoses were 97.3% and 100.0%, respectively. Conclusions The new intuitive grading system accurately and reliably determined the degree of stenosis in intracranial arterial atherosclerosis patients. MRA VICAST could be a versatile alternative to MRA WASID for evaluating intracranial arterial stenosis. Key Points • In this retrospective diagnostic study (sample: 132 stenotic segments), the overall accuracy of the visual grading system (MRA VICAST ) was 94%, and positive predictive value for  >  50% stenosis was 97%. • In the era of medical treatment for intracranial atherosclerotic stenosis, MRA VICAST could be a versatile alternative method to MRA WASID for evaluating intracranial arterial stenosis.

Research on optimizing light intensity to maximize phytochemical production during hemp flowering is limited, despite growing global demand. We investigated the effects of light-emitting diode (LED) intensity on hemp growth, cannabinoid content, and gene expression. Hemp plants ( 'Queen Dream') were grown under white LEDs at light intensities of 200, 400, and 600 μmol·m ·s with a 12/12 h photoperiod for 35 days during the flowering stage. The dry mass of stems, leaves, and flowers increased linearly with increasing light intensity. Cannabinoid analysis revealed that levels of cannabidiol (CBD), cannabidiolic acid, and tetrahydrocannabinolic acid increased linearly with light intensity, reaching the highest levels at 600 μmol·m ·s . Total CBD increased by 36.88% at 600 μmol·m ·s compared to 200 μmol·m ·s . CBD yield per plant also increased linearly across the entire light intensity range. Gene expression analysis revealed a coordinated upregulation of genes involved in the hexanoate-olivetolic acid-cannabigerolic acid-cannabinoid biosynthesis pathway under high light intensity, with a notable increase in cannabidiolic acid synthase ( ) expression. These findings demonstrate that a light intensity of 600 μmol·m ·s effectively enhances both biomass and cannabinoid accumulation at the flowering stage, providing valuable insights for controlled-environment hemp cultivation aimed at maximizing CBD yield.

To investigate the treatment efficacy of intra-arterial (IA) trastuzumab treatment using multiparametric magnetic resonance imaging (MRI) in a human breast cancer xenograft model. Human breast cancer cells (BT474) were stereotaxically injected into the brains of nude mice to obtain a xenograft model. The mice were divided into four groups and subjected to different treatments (IA treatment [IA-T], intravenous treatment [IV-T], IA saline injection [IA-S], and the sham control group). MRI was performed before and at 7 and 14 d after treatment to assess the efficacy of the treatment. The tumor volume, apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE) MRI parameters (Ktrans, Kep, Ve, and Vp) were measured. Tumor volumes in the IA-T group at 14 d after treatment were significantly lower than those in the IV-T group (13.1 mm3 [interquartile range 8.48-16.05] vs. 25.69 mm3 [IQR 20.39-30.29], p = 0.005), control group (IA-S, 33.83 mm3 [IQR 32.00-36.30], p<0.01), and sham control (39.71 mm3 [IQR 26.60-48.26], p <0.001). The ADC value in the IA-T group was higher than that in the control groups (IA-T, 7.62 [IQR 7.23-8.20] vs. IA-S, 6.77 [IQR 6.48-6.87], p = 0.044 and vs. sham control, 6.89 [IQR 4.93-7.48], p = 0.004). Ktrans was significantly decreased following the treatment compared to that in the control groups (p = 0.002 and p<0.001 for vs. IA-S and sham control, respectively). Tumor growth was decreased in the IV-T group compared to that in the sham control group (25.69 mm3 [IQR 20.39-30.29] vs. 39.71 mm3 [IQR 26.60-48.26], p = 0.27); there was no significant change in the MRI parameters. IA treatment with trastuzumab potentially affects the early response to treatment, including decreased tumor growth and decrease of Ktrans, in a preclinical brain tumor model.

Background/Objectives: The cavernous sinus air sign, historically linked to trauma or venous sinus thrombosis, has recently been reported in association with retrograde venous air embolism, often without clinical significance. Despite this, its exact prevalence, etiology, and clinical relevance remain unclear. This study aims to systematically evaluate the incidence of the cavernous sinus air sign in patients undergoing CT angiography (CTA) and to assess its potential clinical implications. Methods: We retrospectively analyzed data from patients who underwent CTA between January 2021 and December 2021. The cavernous sinus air sign was defined radiologically as air-density foci within the cavernous sinus, with Hounsfield units lower than those of orbital fat. Key variables included clinical indications for CTA, evidence of venous reflux of contrast media, the laterality of contrast injection, and the presence of brachiocephalic vein stenosis. Comparative analyses were performed to identify factors associated with the occurrence of the cavernous sinus air sign. Results: Among the 2,821 patients evaluated, the cavernous sinus air sign was identified in 35 cases (1.2%). Notably, none of these patients had a history of trauma or venous sinus thrombosis. Follow-up CT imaging was available for 27 of the 35 cases (77.1%), and in all instances, the cavernous sinus air sign resolved spontaneously. A statistically significant association was found between the cavernous sinus air sign and left-sided peripheral intravenous contrast injection, observed in 8.6% of affected patients compared to 1.5% in those without the sign (p = 0.001). Venous reflux into the internal jugular vein was also more frequent in patients with the air sign (34.3% vs. 14.1%, p = 0.001). These findings suggest a mechanical component, likely related to retrograde air embolism, influenced by anatomical and procedural factors. Conclusions: The isolated presence of the cavernous sinus air sign, in the absence of relevant clinical conditions, is most likely a benign, incidental finding associated with retrograde air embolism.

Background and Purpose: This study aimed to identify the imaging characteristics and discriminate the etiology of acute internal carotid artery occlusion (ICAO) on computed tomography angiography (CTA) in patients with acute ischemic stroke. Materials and Methods: We retrospectively evaluated consecutive patients who underwent endovascular thrombectomy for acute ICAO. Contrast filling of the extracranial ICA in preprocedural CTA was considered apparent ICAO. Non-contrast filling of the extracranial ICA was evaluated according to the contrast-filled lumen configuration, lumen margin and location, Hounsfield units of the non-attenuating segment, and presence of calcification or an intimal flap. Digital subtraction angiography findings were the reference standard for ICAO etiology and the occlusion site. A diagnostic tree was derived using significant variables according to pseudo-occlusion, atherosclerotic vascular disease (ASVD), thrombotic occlusion, and dissection. Results: A total of 114 patients showed apparent ICAO (n = 21), pseudo-occlusion (n = 51), ASVD (n = 27), thrombotic occlusion (n = 9), or dissection (n = 6). Most pseudo-occlusions (50/51, 98.0%) showed dependent locations with ill-defined contrast column margins and classic flame or beak shapes. The most common occlusion site of pseudo-occlusion was the petro-cavernous ICA (n = 32, 62.7%). Apparent ICAO mainly appeared in cases with occlusion distal to the posterior communicating artery orifice. ASVD showed beak or blunt shapes in the presence of low-density plaques or dense calcifications. Dissection revealed flame- or beak-shaped appearances with circumscribed margins. Thrombotic occlusions tended to appear blunt-shaped. The decision-tree model showed a 92.5% overall accuracy. Conclusions: CTA characteristics may help diagnose ICAO etiology. We provide a simple and easy decision-making model to inform endovascular thrombectomy.

Purpose: The purpose of this study is to improve the qualitative and quantitative image quality of the time-resolved angiography with interleaved stochastic trajectories technique (4D-TWIST-MRA) using deep neural network (DNN)-based MR image reconstruction software. Materials and Methods: A total of 520 consecutive patients underwent 4D-TWIST-MRA for ischemic stroke or intracranial vessel stenosis evaluation. Four-dimensional DNN-reconstructed MRA (4D-DNR) was generated using commercially available software (SwiftMR v.3.0.0.0, AIRS Medical, Seoul, Republic of Korea). Among those evaluated, 397 (76.3%) patients received concurrent time-of-flight MRA (TOF-MRA) to compare the signal-to-noise ratio (SNR), image quality, noise, sharpness, vascular conspicuity, and degree of venous contamination with a 5-point Likert scale. Two radiologists independently evaluated the detection rate of intracranial aneurysm in TOF-MRA, 4D-TWIST-MRA, and 4D-DNR in separate sessions. The other 123 (23.7%) patients received 4D-TWIST-MRA due to a suspicion of acute ischemic stroke. The confidence level and decision time for large vessel occlusion were evaluated in these patients. Results: In qualitative analysis, 4D-DNR demonstrated better overall image quality, sharpness, vascular conspicuity, and noise reduction compared to 4D-TWIST-MRA. Moreover, 4D-DNR exhibited a higher SNR than 4D-TWIST-MRA. The venous contamination and aneurysm detection rates were not significantly different between the two MRA images. When compared to TOF-MRA, 4D-CE-MRA underestimated the aneurysm size (2.66 ± 0.51 vs. 1.75 ± 0.62, p = 0.029); however, 4D-DNR showed no significant difference in size compared to TOF-MRA (2.66 ± 0.51 vs. 2.10 ± 0.41, p = 0.327). In the diagnosis of large vessel occlusion, 4D-DNR showed a better confidence level and shorter decision time than 4D-TWIST-MRA. Conclusion: DNN reconstruction may improve the qualitative and quantitative image quality of 4D-TWIST-MRA, and also enhance diagnostic performance for intracranial aneurysm and large vessel occlusion.

Abstract BACKGROUND It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO). OBJECTIVE To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone). METHODS We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success. RESULTS Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187). CONCLUSION CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.

Objective Conventionally, MRI aids in differentiating acute unilateral peripheral vestibulopathy/vestibular neuritis (AUPV/VN) from mimickers. Meanwhile, the diagnostic utility of MRIs dedicated to the inner ear remains to be elucidated for diagnosing AUPV/VN. Methods We prospectively recruited 53 patients with AUPV/VN (mean age ± SD = 60 ± 15 years, 29 men). Initial MRIs were performed with a standard protocol, and an additional axial 3D‐fluid‐attenuated inversion recovery (3D‐FLAIR) sequence was obtained 4 h after intravenous injection of gadoterate meglumine. Abnormal enhancement was defined as a signal intensity that exceeded the mean + 2SD value on the healthy side. The findings of neurotologic evaluation and MRIs were compared. Results Overall, the inter‐rater agreement for gadolinium enhancement was 0.886 (Cohen's kappa coefficient). Enhancement was observed in 26 patients (49%), most frequently in the vestibule (n = 20), followed by the anterior (n = 12), horizontal (HC, n = 8), posterior canal (n = 5), and superior (n = 3) and inferior (n = 1) vestibular nerves. In multivariable logistic regression analysis, the enhancement was associated with decreased HC gain in video head‐impulse tests (p = 0.036), increased interaural difference in ocular vestibular‐evoked myogenic potentials (p = 0.001), and a longer onset‐to‐MRI time span (p = 0.024). The sensitivity and specificity were 92.3% and 81.5%, respectively, with an area under the curve of 0.90 for predicting gadolinium enhancement. Interpretation Robust gadolinium enhancement was observed on 4‐hour‐delayed 3D‐FLAIR images in nearly half of the patients with AUPV/VN, with a good correlation with the results of neurotologic evaluation. The positivity may be determined by the extent of vestibular deficit, timing of imaging acquisition, and possibly by the underlying etiology causing AUPV/VN. MRIs may aid in delineating the involved structures in AUPV/VN.