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Large language models (LLMs) like GPT have been proposed to support complex clinical decision-making. This study evaluated the performance of GPT-based LLM in analyzing clinical, radiological, and laboratory data from patients with hepatocellular carcinoma (HCC) to assess liver function, assign BCLC stage, and recommend treatment. Data from 106 HCC patients (82% male, median age 65 [22–86]) were compiled into anonymized integrated reports. Four GPT-versions (4, o1, o3, 5.4) were prompted—using both short and long instructions—to calculate MELD, ALBI, and Child–Pugh scores, assign BCLC stage, and generate treatment recommendations based on current guidelines. Outputs were compared to expert consensus and tumor board decisions. Errors were categorized by type and source. Time and cost analyses compared GPT to clinical staff. All GPT versions achieved high accuracy (> 85%) in liver function assessment, with MELD calculation being the most error-prone. BCLC staging accuracy ranged from 46.2% (version 4) to 84.0% (o3), with misclassification of radiological reports as the main error source. Reasoning-optimized models (o1, o3) performed best for treatment recommendations, achieving an overall accuracy (correct suggestions and acceptable alternatives) of up to 90.6%. In 9–14% of cases, GPT suggestions were retrospectively more guideline-concordant than tumor board decisions. GPT processing was significantly faster and reduced costs by approximately 300- to 1300-fold compared to clinical staff. GPT-based LLMs show potential as decision-support tools for liver function assessment, BCLC staging, and treatment guidance in HCC. Particularly with reasoning-optimized models and detailed prompting, LLMs may serve as valuable adjuncts in multidisciplinary HCC workflows. However, a non-negligible error rate requires expert oversight and further model refinement.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension; yet the influence of anesthesia modality on procedural performance and hemodynamics remains insufficiently characterized. This retrospective single-center study compared radiation exposure, procedural parameters, and portal hemodynamics between procedures performed with and without general anesthesia (GA). A total of 84 patients were identified, of whom 62 were age- and sex-matched into two equal groups: group 1 (GA, n = 31) and group 2 (no GA, n = 31). Evaluated parameters included length of hospital stay, dose area product (DAP), fluoroscopy time (FT), contrast volume, number of digital subtraction angiography series, procedure duration, and pre- and post-TIPS measurements of portal venous pressure, central venous pressure (CVP), and portosystemic pressure gradient (PPG). Non-parametric statistical tests were applied. Patients in group 1 had significantly shorter postoperative hospital stay (median 6 days; interquartile range (IQR): 4–7) than those in group 2 (8 days; IQR 6–8; p = 0.006). Radiation dose was significantly lower in group 1, with a median DAP of 127.1 Gy*cm 2 (IQR 64.6–201.8) compared to 325 Gy*cm 2 (IQR 162.3–393.7; p = 0.02) in group 2. FT was also reduced under GA (12.2 minutes; IQR 9.6–15.9 vs. 16.0 minutes; IQR 11.5–25.9; p = 0.01), as was contrast volume (75 ml; IQR 60–100 vs. 90 mL; IQR 60–110; p = 0.01). PPG reduction was achieved in both groups, despite higher CVP under GA. These findings suggest that GA may facilitate more stable procedural conditions during TIPS, reducing radiation dose and contrast use without compromising hemodynamic effectiveness.

To evaluate the utility of microRNAs (miRNAs) integrated with current clinical risk models as predictive models for hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). This retrospective proof-of-concept study included 20 patients with HCC who underwent LT between 2007 and 2021 ( n  = 10 recurrent, n  = 10 5-year recurrence-free). MiRNA profiling was performed on formalin-fixed, paraffin-embedded (FFPE) HCC explant tissue at the time of transplantation and clinical data were collected. The predictive value of miRNA expression for HCC recurrence was evaluated in a hybrid data- and hypothesis-driven approach and combined with clinical risk models (Milan, UCSF, Metroticket 2.0 and AFP). Kaplan-Meier analysis was performed to analyze recurrence-free survival (RFS). We identified a 3-miRNA signature - miR-3692-5p, miR-424, and miR-718 - that revealed discriminatory capacity between recurrence and non-recurrence. Adding this signature to clinical models increased the area under the receiver operating characteristic curve (AUC) for modeling HCC recurrence from 0.5 to 0.7 to 0.94–0.96. The combined models were used to categorize patients as high- or low-risk, with patients in the high-risk group having a shorter estimated median RFS (17.0 months vs. 38.5 months, p  < 0.05). Integrating tissue-derived molecular miRNA signatures with existing clinical risk models may enhance the prediction of HCC recurrence following LT. Incorporating molecular approaches into current protocols could refine post-transplant risk stratification and surveillance guidance.

PurposeTo evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand.Materials and MethodsA retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments.ResultsThe mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients.ConclusionPercutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients.Level of EvidenceLevel 4, Retrospective study.

Background Response assessment of targeted cancer therapies is becoming increasingly challenging, as it is not adequately assessable with conventional morphological and volumetric analyses of tumor lesions. The tumor microenvironment is particularly constituted by tumor vasculature which is altered by various targeted therapies. The aim of this study was to noninvasively assess changes in tumor perfusion and vessel permeability after targeted therapy in murine models of breast cancer with divergent degrees of malignancy. Methods Low malignant 67NR or highly malignant 4T1 tumor-bearing mice were treated with either the multi-kinase inhibitor sorafenib or immune checkpoint inhibitors (ICI, combination of anti-PD1 and anti-CTLA4). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with i.v. injection of albumin-binding gadofosveset was conducted on a 9.4 T small animal MRI. Ex vivo validation of MRI results was achieved by transmission electron microscopy, immunohistochemistry and laser ablation-inductively coupled plasma-mass spectrometry. Results Therapy-induced changes in tumor vasculature differed between low and highly malignant tumors. Sorafenib treatment led to decreased tumor perfusion and endothelial permeability in low malignant 67NR tumors. In contrast, highly malignant 4T1 tumors demonstrated characteristics of a transient window of vascular normalization with an increase in tumor perfusion and permeability early after therapy initiation, followed by decreased perfusion and permeability parameters. In the low malignant 67NR model, ICI treatment also mediated vessel-stabilizing effects with decreased tumor perfusion and permeability, while ICI-treated 4T1 tumors exhibited increasing tumor perfusion with excessive vascular leakage. Conclusion DCE-MRI enables noninvasive assessment of early changes in tumor vasculature after targeted therapies, revealing different response patterns between tumors with divergent degrees of malignancy. DCE-derived tumor perfusion and permeability parameters may serve as vascular biomarkers that allow for repetitive examination of response to antiangiogenic treatment or immunotherapy.

The aim of the study was to evaluate the feasibility of intraosseous (i.o.) contrast media injection (CMI) for emergency computed tomography (CT) of severe trauma and the associated image quality compared to intravenous (i.v.) CMI. The authors retrospectively analysed objective (contrast-to-noise ratio (CNR)) and subjective (4-point Likert scale) image quality of CTs after i.o. (n = 4, mean age (y) 57.0±11.0) versus i.v. (n = 20, mean age (y) 58.8±4.4) CMI. All patients underwent a native head CT scan, a cerebral CT angiography (CTA) and CTA of the supra-aortic vasculature as well as a chest and abdominal CT scan in the venous phase; one patient with an i.o. access additionally received a CTA of the lower limbs. Electronic patient records have been reviewed to determine i.o. access related complications. Both groups were consistent in age, heart rate, scan parameters including the flow rate of the contrast agent, resulting in comparable radiation dose levels. The image noise and CNR had no significant difference between the two groups. Scoring the delineation of the main vessels after i.o. CMI showed no significant difference to the i.v. group. There were no CT or i.o. access related complications observed. The i.o. access is a safe and suitable alternative for emergency CMI in CT. Using established protocols good to very good image quality can be achieved, comparable to i.v. CMI. We show for the first time, that i.o. CMI is also feasible for CTA imaging of the head and neck region as well as of pelvic and leg vessels.

Purpose To evaluate the benefit of a contrast-enhanced computed tomography (CT) radiomics-based model for predicting response and survival in patients with colorectal liver metastases treated with transarterial Yttrium-90 radioembolization (TARE). Materials and Methods Fifty-one patients who underwent TARE were included in this single-center retrospective study. Response to treatment was assessed using the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at 3-month follow-up. Patients were stratified as responders (complete/partial response and stable disease, n  = 24) or non-responders (progressive disease, n  = 27). Radiomic features (RF) were extracted from pre-TARE CT after segmentation of the liver tumor volume. A model was built based on a radiomic signature consisting of reliable RFs that allowed classification of response using multivariate logistic regression. Patients were assigned to high- or low-risk groups for disease progression after TARE according to a cutoff defined in the model. Kaplan–Meier analysis was performed to analyze survival between high- and low-risk groups. Results Two independent RF [Energy, Maximal Correlation Coefficient (MCC)], reflecting tumor heterogeneity, discriminated well between responders and non-responders. In particular, patients with higher magnitude of voxel values in an image (Energy), and texture complexity (MCC), were more likely to fail TARE. For predicting treatment response, the area under the receiver operating characteristic curve of the radiomics-based model was 0.75 (95% CI 0.48–1). The high-risk group had a shorter overall survival than the low-risk group (3.4 vs. 6.4 months, p  < 0.001). Conclusion Our CT radiomics model may predict the response and survival outcome by quantifying tumor heterogeneity in patients treated with TARE for colorectal liver metastases.

Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.

Computed tomography (CT) imaging in acute stroke is an established and fairly widespread approach, but there is no data on applicability of intraosseous (IO) contrast administration in the case of failed intravenous (IV) cannula placement. Here, we present the first case of IO contrast administration for CT imaging in suspected acute stroke providing a dedicated CT examination protocol and analysis of achieved image quality as well as a review of available literature.

Background Permanent epiphysiodesis (pED) according to Phemister is an established treatment for leg length discrepancies (LLD) but has largely been replaced by less invasive techniques. Nevertheless, modern pED procedures based on the Phemister principle are still widely used in paediatric orthopaedics for LLD correction and treatment of tall stature. However, the long-term effects of pED on the knee joint remain unclear. This study aimed to evaluate the long-term outcomes of Phemister pED, specifically assessing secondary alterations in knee joint morphology and the incidence of pre-mature osteoarthritis. A clearer understanding of these sequelae may help guide treatment decisions in paediatric orthopaedic care. Materials and methods A retrospective review of our institution’s longitudinal database identified 75 patients who underwent Phemister pED for LLD between 1980 and 2006. Of these, 20 patients met inclusion criteria and were available for long-term evaluation. Their clinical and radiographic outcomes were compared with those of an age- and sex-matched control cohort of ten untreated individuals. Clinical and radiographic assessments included LLD, mechanical axis deviation, joint orientation angles, central knee anatomy and osteoarthritis grading. Patient-reported outcomes were evaluated using the Oxford Knee Score (OKS), EQ-5D-3L and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results The median follow-up was 37 years (interquartile range 33–39). The mean pre-operative LLD of 2.8 cm (standard deviation (SD) 0.7) was reduced to 1.1 cm (SD 0.6) at last follow-up, although 55% of patients had residual LLD > 1 cm. No relevant differences in joint alignment or central knee anatomy were found between patients and controls. Mild knee osteoarthritis (Kellgren–Lawrence grade 1) was observed in two patients and none in controls. Patient-reported outcomes showed lower OKS and EQ-5D-3L scores in the pED group, although KOOS scores were similar. Conclusions Phemister pED showed satisfactory long-term results for LLD correction, without secondary angular or intra-articular deformities or relevant knee osteoarthritis. Despite slightly lower function and more discomfort, findings support the use of modern pED techniques based on the Phemister principle. This is especially relevant for elective indications such as tall stature. Further comparative studies with percutaneous methods remain necessary to confirm these observations. Level of evidence Level IV, therapeutic study.