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Several cases of vaccine-associated manifestations have been published including cases of inflammatory myositis. Herein, we comprehensively review the literature on the occasion of case of a woman with inflammatory myositis following COVID-19 vaccination. A 67-year-old woman presented with left arm edema, rash, and weakness after the 2nd dose of the BTN162b2 vaccine. Raised muscle enzymes and inflammatory markers with muscle edema on MRI and myositis findings on the electromyogram established the diagnosis. She was successfully treated with methylprednisolone pulses, intravenous immunoglobulin, methotrexate, and hydroxychloroquine. Cases of inflammatory myositis, dermatomyositis, or interstitial lung disease with myositis-specific autoantibodies or myositis-associated autoantibodies within 12 weeks from SARS-CoV-2 vaccination were included. Cases with malignancy, prior or subsequent COVID-19 infection, preexisting myositis/interstitial lung disease (ILD)/dermatomyositis (DM), or other connective tissue diseases were excluded. From our search, 49 cases were identified (mean age: 56.55 + 17.17 years), 59% were women, while 12 patients received the ChAdOx1 vaccine, 27 the BNT162b2, 8 the mRNA-1273, 1 the DB15806, and 1 the Ad26.COV2.S (overall, 70% received mRNA vaccines). Muscle involvement was the most common manifestation (79.5%), followed by skin involvement (53%) and ILD (34.6%), which were more common in the m-RNA vaccinees. Muscle biopsy, MRI findings, and autoantibody profile varied significantly, while successful immunosuppressive treatment was applied in most cases. Inflammatory myositis after COVID-19 vaccination has been well documented worldwide. Current evidence in support of a pathogenic link is challenging due to significant variation in clinical manifestations, radiological, histopathological, and immunological features.

The improved treatment of knee injuries critically relies on having an accurate and cost-effective detection. In recent years, deep-learning-based approaches have monopolized knee injury detection in MRI studies. The aim of this paper is to present the findings of a systematic literature review of knee (anterior cruciate ligament, meniscus, and cartilage) injury detection papers using deep learning. The systematic review was carried out following the PRISMA guidelines on several databases, including PubMed, Cochrane Library, EMBASE, and Google Scholar. Appropriate metrics were chosen to interpret the results. The prediction accuracy of the deep-learning models for the identification of knee injuries ranged from 72.5–100%. Deep learning has the potential to act at par with human-level performance in decision-making tasks related to the MRI-based diagnosis of knee injuries. The limitations of the present deep-learning approaches include data imbalance, model generalizability across different centers, verification bias, lack of related classification studies with more than two classes, and ground-truth subjectivity. There are several possible avenues of further exploration of deep learning for improving MRI-based knee injury diagnosis. Explainability and lightweightness of the deployed deep-learning systems are expected to become crucial enablers for their widespread use in clinical practice.

Background/Objectives: Radiomics enables extraction of quantitative imaging features to support non-invasive classification of prostate cancer (PCa). Accurate detection of clinically significant PCa (csPCa; Gleason score ≥ 3 + 4) is crucial for guiding treatment decisions. However, many studies explore limited feature selection, classifier, and harmonization combinations, and lack external validation. We aimed to systematically benchmark modeling pipelines and evaluate whether combining radiomics with the lesion-to-normal ADC ratio improves classification robustness and generalizability in multicenter datasets. Methods: Radiomic features were extracted from ADC maps using IBSI-compliant pipelines. Over 100 model configurations were tested, combining eight feature selection methods, fifteen classifiers, and two harmonization strategies across two scenarios: (1) repeated cross-validation on a multicenter dataset and (2) nested cross-validation with external testing on the PROSTATEx dataset. The ADC ratio was defined as the mean lesion ADC divided by contralateral normal tissue ADC, by placing two identical ROIs in each side, enabling patient-specific normalization. Results: In Scenario 1, the best model combined radiomics, ADC ratio, LASSO, and Naïve Bayes (AUC-PR = 0.844 ± 0.040). In Scenario 2, the top-performing configuration used Recursive Feature Elimination (RFE) and Boosted GLM (a generalized linear model trained with boosting), generalizing well to the external set (AUC-PR = 0.722; F1 = 0.741). ComBat harmonization improved calibration but not external discrimination. Frequently selected features were texture-based (GLCM, GLSZM) from wavelet- and LoG-filtered ADC maps. Conclusions: Integrating radiomics with the ADC ratio improves csPCa classification and enhances generalizability, supporting its potential role as a robust, clinically interpretable imaging biomarker in multicenter MRI studies.

Background: The anatomical relationship between the carotid arteries (CAs) and the hyoid bone (HB) has significant clinical implications. The present study investigates the spatial relationship between the HB and common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid bifurcation (CB), analyzing their morphological variants and topographical associations. Materials and Methods: Computed tomography angiographies (CTAs) from 100 patients (50 males, 50 females; mean age 62.2 ± 14.5 years) were analyzed. Measurements included the HB greater horn length (GHL) and greater horn angle (GHA), CA distances, and classification of relationships of the CAs with the HB. Results: The mean GHL was 27.72 ± 3.91 mm, and the mean GHA was 110.36 ± 6.06 degrees. Males exhibited significantly longer GHs than females (p < 0.001). Suprahyoid bifurcations occurred in 35.5% of cases, with a mean CCA-GH distance of 4.54 ± 2.67 mm. Infrahyoid bifurcations were identified in 64.5% of cases, with mean ECA-GH and ICA-GH distances of 4.10 ± 3.11 mm and 6.72 ± 3.85 mm, respectively. GHL significantly influenced these distances. Type 6 (ECA positioned laterally to the GH) was the most prevalent carotid–hyoid configuration (18.5%). Conclusions: The present study provides essential insights into the topographical variability of the CAs relative to the HB, offering valuable guidance for surgical planning and vascular risk assessment. These findings are crucial for procedures such as carotid endarterectomy, where the proximity of the carotid arteries to the hyoid bone impacts the risk of vascular injury. Further research is warranted to explore the clinical implications of these anatomical relationships.

BackgroundThis study aimed to assess the outcomes of contrast-enhanced intraoperative ultrasound (CE-IOUS) for patients with colorectal liver metastases (CRLMs) undergoing surgery.MethodA thorough literature search was performed in PubMed, Scopus, and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated, by means of Random-Effects model.ResultsEleven articles met the inclusion criteria and incorporated 497 patients. The present study shows that CE-IOUS is associated with higher sensitivity and accuracy compared with multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and intraoperative ultrasound (IOUS) in identifying CRLMs (p < 0.05). The positive predictive value was similar among the different modalities. Furthermore, new CRLMs were identified by CE-IOUS, thus affecting the surgical plan in 128 patients (51.8% of the patients with new CRLMs). Moreover, 91 patients (71%) underwent a more extensive hepatectomy and 15 patients (11.7%) were considered non-operable. Two alternative contrast agents, Sonazoid and Sonovue, were employed with similar sensitivity (p > 0.05).ConclusionThese outcomes suggest the superiority of the CE-IOUS over MDCT, MRI, and IOUS for the staging of patients with CRLMs undergoing surgery. However, they should be treated with caution given the small number of the included studies.Graphic abstract

BackgroundThis study aimed to evaluate the outcomes of high-intensity focused ultrasound (HIFU) on patients with advanced pancreatic cancer.MethodsA literature search was performed in PubMed, Scopus and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated by means of the Random-Effects model.ResultsNineteen articles met the inclusion criteria, incorporating 939 patients. This study reveals that patients in the HIFU group presented increased median overall survival (OS), along with higher OS at 6 and 12 months after treatment compared with the control group (p < 0.05). Furthermore, patients treated with HIFU in conjunction with chemotherapy presented reduced levels of pain (p < 0.05) compared to the traditional treatment group. In addition, HIFU contributed to significant tumor responsiveness, in terms of CA19-9 reduction (p < 0.05). Finally, HIFU was a considerably safe treatment modality with a low incidence of complications.ConclusionThese outcomes suggest that HIFU is a feasible and safe treatment modality for patients with advanced pancreatic cancer and provides enhanced outcomes regarding survival and quality of life. Given the lack of a significant number of randomized clinical trials, this meta-analysis represents the best currently available evidence. New randomized trials assessing HIFU are necessary to further evaluate their outcomes.Graphic abstract

Background/Objectives: This study aimed to assess the potential of sternal morphometric parameters derived from multidetector computed tomography (MDCT) for sex estimation in a contemporary Greek population. A secondary objective was to develop and evaluate statistical and machine learning models based on these measurements for forensic identification. Methods: Sternal measurements were obtained from chest MDCT scans of 100 Greek adults (50 males, 50 females). Morphometric variables included total sternum length, surface area, angle, and index (SL, SSA, SA, and SI); manubrium length, width, thickness, and index (MBL, MBW, MBT, and MBI); sternal body length, width, thickness, and index (SBL, SBW, SBT, and SBI); and xiphoid process length and thickness (XPL and XPT). Logistic regression and a Random Forest classifier were applied to assess the predictive accuracy of these parameters. Results: Both models showed high classification performance. Logistic regression identified MBL and SBL as the most predictive variables, yielding 91% overall accuracy, with 92% sensitivity and 90% specificity. The Random Forest model achieved comparable results (91% accuracy, 88% sensitivity, 93% specificity), ranking SSA as the most influential feature. Conclusions: MDCT-derived sternal morphometry provides a reliable, non-invasive method for sex estimation. Parameters such as MBL, SBL, and SSA demonstrate strong discriminatory power and support the development of population-specific standards for forensic applications.

Background: Biologic agents used in patients with inflammatory bowel diseases (IBD) may influence the pathophysiology of coexistent metabolic-dysfunction associated steatotic liver disease (MASLD). This study primarily aimed to evaluate the six-month effect of infliximab or vedolizumab vs. no biologics on presumed hepatic steatosis in patients with IBD. Secondary endpoints were their effect on hepatic fibrosis and parameters related to hepatic metabolism. Methods: This prospective, non-randomized, controlled trial assigned adult bio-naïve patients with IBD into three groups: infliximab, vedolizumab, or controls (receiving no biologic). The baseline was the time of the initiation of biologic agents and the endpoint six months later. Hepatic steatosis was evaluated with transabdominal ultrasonography (Hamaguchi score), whereas controlled attenuation parameter (CAP), fatty liver index (FLI), and hepatic steatosis index (HSI) were used as surrogates. Hepatic fibrosis was evaluated with liver stiffness (LS), fibrosis-4 index (FIB-4), and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Results: Sixty-six patients were assigned to infliximab (n = 26), vedolizumab (n = 14), or control (n = 26); At the endpoint, the Hamaguchi score, CAP, FLI, and HSI were not different between groups. LS was not different between groups; however, FIB-4 was increased within all groups, and NAFLD fibrosis score was increased within infliximab and control groups, without significant biologic × time interactions. Conclusions: No positive or adverse effect of infliximab or vedolizumab vs. no biologic agents was shown on presumed hepatic steatosis in patients with IBD, who have not been previously exposed to biologic agents. Although no effect of both biologic agent on LS, a slight but significant increase in FIB-4 and NAFLD fibrosis score warrants further studying.

Purpose. Bone mineral density (BMD) was measured in uncomplicated young adult patients with type 1 diabetes mellitus (T1DM) and sex- and age-matched controls, using both dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to investigate their diagnostic ability in detecting abnormal values in these patients. Methods. 118 patients with T1DM (65 females, mean age 30.12±8.78 years) and 94 sex- and age-matched controls were studied. BMD was assessed in all participants by DXA and QCT at lumbar spine (LS). Biochemical markers of bone metabolism were also measured. Results. T1DM was associated with lower BMD at L1-L3 vertebrae measured by both DXA and QCT and lower bone turnover compared to sex- and age-matched controls. In T1DM subjects, QCT detected more patients with abnormal BMD values compared to DXA. BMI and HbA1c levels were the only determinants of BMD. Bone turnover markers were lower in patients with longer duration of diabetes. Conclusion. QCT provides a higher sensitivity compared to DXA in detecting abnormal BMD values in patients with uncomplicated T1DM. In these patients, the diabetes-related decreased BMD may be present early, before it is detected by DXA, the clinical gold standard for BMD measurements, and before the presence of any other diabetes complications, stressing the importance of an early intervention for fracture prevention.

Background and Objectives: End-stage renal failure (ESRF) patients are at an increased risk of various neurological complications, particularly after hemodialysis. The current case report describes a rare presentation of spontaneous intracranial hypotension (SIH) in a patient with ESRF caused by systemic lupus erythematosus (SLE). Methods: We present our case report. We also performed a systematic literature search in PubMed, Scopus, and Dimensions for the current literature review. Results: A total of 296 unique articles were identified, and their full text was retrieved. However, only one case report was relevant to our study and is summarized thereunder. The treatment approach involved high-dose intravenous steroids, surgical evacuation of the cranial subdural collections, and epidural blood patches to seal the presumed dural defect. Conclusions: This case report describes a rare presentation of SIH in a young patient with ESRF due to SLE. Diagnostic imaging revealed extensive subdural and epidural fluid collections in the brain and spinal cord, respectively, along with a few T2 FLAIR hyperintensities noted in the right thalamus, left cerebellar hemisphere, and right occipital gyrus that subsequently resolved. The treatment approach involved high-dose intravenous steroids, surgical evacuation of the cranial subdural collections, and epidural blood patches to seal the presumed dural defect.