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BackgroundTraumatic vertebral fractures present a significant diagnostic challenge in emergency settings. Magnetic resonance imaging (MRI) excels in detecting bone marrow edema but faces practical limitations in acute trauma care. This prospective study evaluates the diagnostic accuracy of Dual-Energy Computed Tomography (DECT) in detecting traumatic vertebral bone marrow edema within a Level I trauma center environment.MethodsBetween May 2020 and July 2023, 291 DECT examinations were performed on adult patients presenting with suspected or confirmed spinal injury. From these, 233 (80.1%) met quality criteria for analysis. A subgroup of 47 patients underwent additional MRI as reference standard, with 44 (93.6%) providing diagnostically evaluable images. Two board-certified radiologists independently assessed vertebral bone marrow edema presence in blinded, randomized evaluations using both modalities. Diagnostic parameters, examination times, radiation exposure, and cost-efficiency were analyzed.ResultsDECT demonstrated an overall sensitivity of 82.9% and specificity of 96.6% for detecting vertebral bone marrow edema compared to MRI. The thoracolumbar junction showed highest sensitivity (91.7% for L3). DECT examination time was 7.2 minutes (including post-processing) versus 12 minutes for MRI, meaning MRI required 66.7% more time than DECT. DECT radiation exposure showed a mean dose-length product increase of only 3% compared to conventional CT. Body mass index showed no significant influence on DECT interpretability (p=0.196) or diagnostic accuracy except in isolated segments (L3, T11). Cost-benefit analysis revealed potential savings of 49.1% (€104.40) per spinal segment with DECT-based diagnostic pathways.ConclusionDECT offers high diagnostic accuracy for detecting traumatic vertebral bone marrow edema with substantial time and cost advantages compared to MRI. The technique demonstrates particular value in acute trauma settings, while acknowledging limitations from artifacts (19.9% of cases) primarily caused by medical devices. These findings support implementing DECT as an efficient alternative to MRI in spinal trauma diagnostics.

To retrospectively assess the interreader reproducibility and reliability of EOS 3D full spine reconstructions in patients with adolescent idiopathic scoliosis (AIS). 73 patients with mean age of 17 years and a moderate AIS (median Cobb Angle 18.2°) obtained low-dose standing biplanar radiographs with EOS. Two independent readers performed \"full spine\" 3D reconstructions of the spine with the \"full-spine\" method adjusting the bone contour of every thoracic and lumbar vertebra (Th1-L5). Interreader reproducibility was assessed regarding rotation of every single vertebra in the coronal (i.e. frontal), sagittal (i.e. lateral), and axial plane, T1/T12 kyphosis, T4/T12 kyphosis, L1/L5 lordosis, L1/S1 lordosis and pelvic parameters. Radiation exposure, scan-time and 3D reconstruction time were recorded. Interclass correlation (ICC) ranged between 0.83 and 0.98 for frontal vertebral rotation, between 0.94 and 0.99 for lateral vertebral rotation and between 0.51 and 0.88 for axial vertebral rotation. ICC was 0.92 for T1/T12 kyphosis, 0.95 for T4/T12 kyphosis, 0.90 for L1/L5 lordosis, 0.85 for L1/S1 lordosis, 0.97 for pelvic incidence, 0.96 for sacral slope, 0.98 for sagittal pelvic tilt and 0.94 for lateral pelvic tilt. The mean time for reconstruction was 14.9 minutes (reader 1: 14.6 minutes, reader 2: 15.2 minutes, p<0.0001). The mean total absorbed dose was 593.4μGy ±212.3 per patient. EOS \"full spine\" 3D angle measurement of vertebral rotation proved to be reliable and was performed in an acceptable reconstruction time. Interreader reproducibility of axial rotation was limited to some degree in the upper and middle thoracic spine due the obtuse angulation of the pedicles and the processi spinosi in the frontal view somewhat complicating their delineation.

We investigated the effect of deep learning-based image reconstruction (DLIR) compared to iterative reconstruction on image quality in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). For 220 patients with suspected PE, CTPA studies were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASiR-V 30%, 60% and 90%) and DLIR (low, medium and high strength). Contrast-to-noise ratio (CNR) served as the primary parameter of objective image quality. Subgroup analyses were performed for normal weight, overweight and obese individuals. For patients with confirmed PE (n = 40), we further measured PE-specific CNR. Subjective image quality was assessed independently by two experienced radiologists. CNR was lowest for FBP and enhanced with increasing levels of ASiR-V and, even more with increasing strength of DLIR. High strength DLIR resulted in an additional improvement in CNR by 29–67% compared to ASiR-V 90% (p < 0.05). PE-specific CNR increased by 75% compared to ASiR-V 90% (p < 0.05). Subjective image quality was significantly higher for medium and high strength DLIR compared to all other image reconstructions (p < 0.05). In CT pulmonary angiography, DLIR significantly outperforms iterative reconstruction for increasing objective and subjective image quality. This may allow for further reductions in radiation exposure in suspected PE.

Current guidelines suggest surgical decompression for ischemic cerebellar stroke in case of significant mass effect. Recent research has aimed to identify a possible threshold for mass effect. However, a computer-assisted volumetry in acute setting is time consuming and impracticable, wherefore the aim of this study was to assess the accuracy and clinical applicability of the ABC/2 method in case of ischemic cerebellar stroke. Imaging data of 125 patients, including preoperative CT or MRI scans were used for volumetric analysis. The ABC/2 formula using scans in axial and coronal planes. BrainLab® Elements software was used for computer assisted volumetry by defining the region of interest allowing automated volumetric calculation. Measurements were conducted independently by blinded clinicians. Pearson correlation and Bland-Altmann test were used for statistical analysis. Among the 125 cerebellar infarctions analyzed, there was no statistical difference of mean infarct volume measurement between the ABC/2 formula and computer-assisted volumetry (16.6mL vs. 15.91mL; range 0.8-67.7mL; p = 0.76). The Spearman correlation test indicated a strong correlation between the two methods (r = 0.985, 95% CI: 0.979-0.990, p < 0.0001). Discrepancies were most notable in smaller infarction volumes (<10 mL), prompting a subgroup analysis. For infarct volume less than 10mL, the ratio of volumetric differences ranged from 47% to 60%, with absolute volume differences from -3-3 mL whereas the ratio ranged from -20% to 29%, with absolute volume differences from -6-8 mL in cases with infarct volume greater equal 10mL. ABC/2 formula shows a good correlation with computer-assisted volumetry. Consequently, it could serve as a fast and practical tool for estimating cerebellar infarct volume and aiding decision-making in clinical practice. However, the limitations and variability of the ABC/2 method, particularly for smaller infarcts, must be considered.

Cations with suitable sizes to occupy an interstitial site of perovskite crystals have been widely used to inhibit ion migration and promote the performance and stability of perovskite optoelectronics. However, such interstitial doping inevitably leads to lattice microstrain that impairs the long-range ordering and stability of the crystals, causing a sacrificial trade-off. Here, we unravel the evident influence of the valence states of the interstitial cations on their efficacy to suppress the ion migration. Incorporation of a trivalent neodymium cation (Nd 3+ ) effectively mitigates the ion migration in the perovskite lattice with a reduced dosage (0.08%) compared to a widely used monovalent cation dopant (Na + , 0.45%). The photovoltaic performances and operational stability of the prototypical perovskite solar cells are enhanced with a trace amount of Nd 3+ doping while minimizing the sacrificial trade-off. Ion migration has a detrimental effect on the performance and stability of halide perovskite optoelectronics. Here, the authors incorporated a small dosage of high-valence neodymium cation to suppress this, with a minimal impact on the lattice microstrain.

PurposeEvaluation of the success of periradicular infiltration and facet joint infiltration in a multicenter and prospective approach.Materials and methods114 patients undergoing therapeutic nerve root or facet joint infiltration for radicular and/or facet joint symptoms between the first lumbar and the first sacral segments were prospectively and consecutively enrolled across nine participating study centers in Germany. These centers provide CT-guided pain procedures continuously over a period of 96 months. Assessment was carried out by means of a systematic patient survey including pain questionnaires. The severity of the pain and the impairment caused by pain were assessed using 11-point Numerical Rating Scales.ResultsCT-guided periradicular infiltration and facet joint infiltration significantly reduced pain levels and substantially reduced pain frequency at all time points and up to three months after the last intervention. All pain related characteristics (i.e. actual pain, average pain level, maximum pain level) were significantly (95% confidence intervals (CI) ranging between − 1.0 and − 5.0) reduced at all time points when compared to the baseline. Besides the pure pain levels, the presented data also provide detailed insights into the complex associated issues the patient collective is facing including impairment in everyday life, fitness for work and leisure time activities. These parameters were also substantially improved (95% CI between − 0.0 and − 5.0) at all time points indicating a comprehensive patient benefit. Self-reported patient satisfaction, recommendation of the procedure and personal success were rated high (62–100%). The rate of patients on sick leave dropped from 23.7 to 1.9%. Accordingly, patients reported a high rate of satisfaction with the procedures. There was a high technical and clinical success rate with no major complications.ConclusionCT-guided pain therapy on the lumbar spine is effective and safe with a comprehensive benefit for patients, including not only pain levels in the narrow meaning but also regarding everyday life, fitness for work and leisure time activities at all investigated time points including 3 months follow-up.

Objective To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability. Methods Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded. Results Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23. Conclusion Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability. Clinical relevance statement For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients. Key Points • Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. • Additional fluoroscopy may be important for therapeutic injections. • The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.

ObjectivesImaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building.MethodsA validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics (‘General issues’, ‘Parameters and reporting’, ‘Radiographic assessment’, ‘MRI’ and ‘Ultrasound’) in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either ‘consensus’, ‘agreement’ or ‘no agreement’ was achieved.ResultsForty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to ‘Ultrasound’.ConclusionRadiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI.Key Points• FAI imaging literature is extensive although often of low level of evidence.• Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment.• MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.

Impaired muscle regeneration has repeatedly been described after anterior cruciate ligament reconstruction (ACL-R). The results of recent studies provided some evidence for negative alterations in knee extensor muscles after ACL-R causing persisting strength deficits in spite of the regain of muscle mass. Accordingly, we observed that 12 weeks of concentric/eccentric quadriceps strength training with eccentric overload (CON/ECC + ) induced a significantly greater hypertrophy of the atrophied quadriceps muscle after ACL-R than conventional concentric/eccentric quadriceps strength training (CON/ECC). However, strength deficits persisted and there was an unexpected increase in the proportion of slow type I fibers instead of the expected shift towards a faster muscle phenotype after CON/ECC + . In order to shed further light on muscle recovery after ACL-R, the steady-state levels of 84 marker mRNAs were analyzed in biopsies obtained from the vastus lateralis muscle of 31 subjects before and after 12 weeks of CON/ECC + (n = 18) or CON/ECC strength training (n = 13) during rehabilitation after ACL-R using a custom RT 2 Profiler PCR array. Significant (p < 0.05) changes were detected in the expression of 26 mRNAs, several of them involved in muscle wasting/atrophy. A different pattern with regard to the strength training mode was observed for 16 mRNAs, indicating an enhanced hypertrophic stimulus, mechanical sensing or fast contractility after CON/ECC + . The effects of the type of autograft (quadriceps, QUAD, n = 19, or semitendinosus tendon, SEMI, n = 12) were reflected in the lower expression of 6 mRNAs involved in skeletal muscle hypertrophy or contractility in QUAD. In conclusion, the greater hypertrophic stimulus and mechanical stress induced by CON/ECC + and a beginning shift towards a faster muscle phenotype after CON/ECC + might be indicated by significant gene expression changes as well as still ongoing muscle wasting processes and a negative impact of QUAD autograft.

Purpose To investigate the test–retest repeatability of radiomic features in myocardial native T1 and T2 mapping. Methods In this prospective study, 50 healthy volunteers (29 women and 21 men, mean age 39.4 ± 13.7 years) underwent two identical cardiac magnetic resonance imaging (MRI) examinations at 1.5 T. The protocol included native T1 and T2 mapping in both short-axis and long-axis orientation. For T1 mapping, we investigated standard (1.9 × 1.9 mm) and high (1.4 × 1.4 mm) spatial resolution. After manual segmentation of the left ventricular myocardium, 100 radiomic features from seven feature classes were extracted and analyzed. Test–retest repeatability of radiomic features was assessed using the intraclass correlation coefficient (ICC) and classified as poor (ICC < 0.50), moderate (0.50–0.75), good (0.75–0.90), and excellent (> 0.90). Results For T1 maps acquired in short-axis orientation at standard resolution, repeatability was excellent for 6 features, good for 29 features, moderate for 19 features, and poor for 46 features. We identified 15 features from 6 classes which showed good to excellent reproducibility for T1 mapping in all resolutions and all orientations. For short-axis T2 maps, repeatability was excellent for 6 features, good for 25 features, moderate for 23 features, and poor for 46 features. 12 features from 5 classes were found to have good to excellent repeatability in T2 mapping independent of slice orientation. Conclusion We have identified a subset of features with good to excellent repeatability independent of slice orientation and spatial resolution. We recommend using these features for further radiomics research in myocardial T1 and T2 mapping. Key Points Question The study addresses the need for reliable radiomic features for quantitative analysis of the myocardium to ensure diagnostic consistency in cardiac MRI. Findings We have identified a subset of radiomic features demonstrating good to excellent repeatability in native T1 and T2 mapping independent of slice orientation and resolution. Clinical relevance Radiomic features have been proposed as diagnostic and prognostic biomarkers in various heart diseases. By identifying a subset of particularly reproducible radiomic features our study serves to inform the selection of radiomic features in future research and clinical applications. Graphical Abstract