Osteomas of the temporal bone are rare benign tumors that, in a small minority of cases, may give rise to secondary cholesteatoma. We report a case in which two independent pathological mechanisms appeared to coexist, resulting in a configuration not previously described in the literature. A 51-year-old woman presented with one year of right-sided otorrhoea and progressive mixed hearing loss unresponsive to antibiotic therapy. High-resolution computed tomography (HRCT) demonstrated a giant sessile osteoma arising from the anterior mastoid cortex with complete external auditory canal (EAC) obstruction. Non-echo-planar diffusion-weighted MRI (non-EPI DWI-MRI) identified cholesteatoma restricted to the middle ear and mastoid antrum, clearly distinct from chronically inflamed mastoid air cells. Intraoperatively, a near-intact tympanic membrane with a small attic retraction pocket formed the anterior boundary; no canal-wall cholesteatoma was present. Canal wall-down (CWD) radical mastoidectomy with osteoma excision and meatoconchoplasty achieved complete disease eradication. Histopathology confirmed compact osteoma and cholesteatoma. The cavity was dry and stable at the three-month follow-up. Upon review of the published case reports of temporal bone osteoma with associated cholesteatoma, no previously reported case combined a giant osteoma of the anterior mastoid cortex with cholesteatoma confined entirely to the middle ear and mastoid behind a structurally preserved tympanic membrane. The intraoperative finding of an attic retraction pocket suggests that Eustachian tube dysfunction may have played an independent contributory role alongside the osteoma. Combined HRCT and non-EPI DWI-MRI was essential for preoperative characterization and surgical planning.
Autoimmune thyroiditis represents the most common cause of thyroid dysfunction in women of reproductive age and is frequently encountered during pregnancy. The presence of thyroid autoantibodies, particularly anti-thyroid peroxidase antibodies, has been associated with adverse obstetric outcomes even in the absence of overt thyroid dysfunction. However, optimal screening, monitoring, and treatment strategies remain areas of ongoing debate. This study aimed to review recent evidence on the epidemiology, clinical impact, diagnosis, management, and emerging research directions of autoimmune thyroiditis in pregnancy. A narrative review of observational studies, randomized controlled trials, meta-analyses, and international clinical guidelines published predominantly within the last five years was conducted, focusing on maternal and fetal outcomes, diagnostic approaches, and therapeutic strategies. Autoimmune thyroiditis affects a substantial proportion of pregnant women worldwide and is associated with increased risks of miscarriage, preterm delivery, hypertensive disorders of pregnancy, and postpartum thyroiditis. These associations are observed not only in women with overt or subclinical hypothyroidism but also in euthyroid women with thyroid autoimmunity. While levothyroxine therapy is clearly indicated in overt and selected cases of subclinical hypothyroidism, evidence does not support routine treatment in euthyroid antibody-positive women. Current guidelines recommend targeted screening and close biochemical monitoring rather than universal intervention. Autoimmune thyroiditis in pregnancy is a clinically relevant condition with important implications for maternal and fetal health. A risk-stratified, individualized approach to diagnosis and management is essential, balancing the benefits of treatment against the risks of overtreatment. Further high-quality research is needed to refine risk prediction and identify subgroups that may benefit from targeted therapeutic interventions.
This study aimed to compare the efficacy and short-term tolerability of microneedling combined with either tranexamic acid or vitamin C for melasma. A systematic review and meta-analysis following PRISMA 2020 guidelines was conducted across five databases (MEDLINE, Google Scholar, EBSCO, ProQuest, Web of Science) and ClinicalTrials.gov (2015-2025). Eight studies (232 patients) were synthesized using a random-effects model; outcomes were harmonized across MASI, mMASI, and hemi-MASI using Hedges' g calculated from within-group change-from-baseline scores, with an imputed within-person correlation (r = 0.5; sensitivity range 0.25-0.75) for split-face designs. The pooled analysis showed no statistically significant difference between tranexamic acid and vitamin C (Hedges' g = -0.123; 95% CI, -0.311 to 0.065; P = 0.201; I2 = 0.0%). Exploratory subgroup analyses by microneedling depth, study design, and follow-up duration did not detect a significant interaction but were underpowered and should not be interpreted as confirmatory. Within the short follow-up windows reported (6-16 weeks), both interventions appeared well tolerated, with only mild and transient adverse events; long-term safety, recurrence, and delayed pigmentary complications cannot be characterized from this evidence base. A non-significant pooled difference does not establish therapeutic equivalence in the absence of a pre-specified non-inferiority margin. Microneedling with TXA and microneedling with vitamin C showed comparable short-term outcomes within this limited evidence base. Available data are compatible with a needle depth of ≤1.5 mm being adequate for transdermal delivery. Findings should be interpreted with caution given the modest sample size, predominance of split-face designs, moderate risk of bias in non-randomized studies, and limited power to detect publication bias.
Basilar artery occlusion (BAO) is an uncommon yet devastating cause of posterior circulation stroke, frequently resulting in severe disability or death despite successful reperfusion. We describe a 67-year-old woman with multiple vascular risk factors who presented with acute BAO and was treated with intravenous thrombolysis followed by successful mechanical thrombectomy (Thrombolysis in Cerebral Infarction [TICI] grade 3), with adjunctive Cerebrolysin therapy administered subsequently. Rapid neurological improvement was observed within 24 hours, with the National Institutes of Health Stroke Scale (NIHSS) score decreasing from 7 to 2, followed by complete neurological recovery (NIHSS 0) by day 3. Clinical recovery was sustained throughout the 12-month follow-up period, with only mild residual gait disturbance noted at discharge. No adverse events attributable to Cerebrolysin were observed. Successful reperfusion remains the key determinant of outcome in BAO, and no causal inference can be made regarding Cerebrolysin. This case adds to the limited evidence on the use of Cerebrolysin as an adjunct to reperfusion therapy and supports further investigation in controlled studies of posterior circulation stroke.
This study investigated the effects of ashwagandha root extract (ARE) supplementation on core attention-deficit/hyperactivity disorder (ADHD) symptoms, executive functioning, and patient-reported outcomes in children and adolescents with mild ADHD. Fifty-eight children and adolescents with clinically diagnosed mild ADHD were randomly assigned to either the ARE group (ARE; n = 29) or a placebo group (PLA; n = 29) in a prospective, randomized, double-blind, placebo-controlled, parallel-group design. Participants received 150 mg of ashwagandha root extract or a matched placebo gummies twice daily for 56 days. Primary outcomes were changes in the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) total score. Secondary outcomes: ADHD-RS-IV inattention and hyperactivity-impulsivity subscales, Behavior Rating Inventory of Executive Function-2 (BRIEF-2) scores and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Safety markers, including routine clinical laboratory parameters, were assessed at baseline and Day 56. At Day 56, ADHD-RS-IV inattention, hyperactivity-impulsivity, and total scores were significantly lower in ARE than in PLA (P < 0.001). Significant improvements were also observed in the BRIEF-2 behavioral, emotional, and cognitive regulation indices and the global executive composite in ARE (P < 0.001). PROMIS sleep disturbance and anxiety scores improved significantly in ARE relative to PLA (P < 0.001). No significant between-group differences or clinically meaningful changes were observed in safety markers across the intervention period. No serious adverse events were reported. Supplementation with 300 mg/day of ashwagandha root extract for 56 days significantly improved ADHD symptom severity, executive functioning, and selected patient-reported outcomes in children and adolescents with mild ADHD, with a favorable safety profile.
Living kidney donation is the treatment of choice for patients with end-stage kidney disease, yet the long-term psychosocial and socioeconomic consequences for donors remain incompletely characterized, particularly in Eastern European cohorts. This study aimed to assess the long-term psychosocial and socioeconomic impact of living kidney donation in a single-center Romanian cohort and to compare donor-reported outcomes by kidney function at last follow-up. We conducted a retrospective cross-sectional assessment of living kidney donors who underwent nephrectomy at a single Romanian transplant center between January 2015 and December 2019. Of an initial cohort of 142 living kidney donors, six had died during follow-up; the remaining 136 donors were evaluated at a mean follow-up of 100.97 ± 17.89 months. Adverse outcomes were stratified by kidney function at last follow-up (eGFR < 45 vs ≥ 45 mL/min/1.73 m2). Overall, living kidney donors reported no regret (0%), no family disruption (0%), no financial burden (0%), and no occupational change (0%), along with low rates of depression (5.1%), anxiety (5.9%), and fear of kidney failure (2.2%). However, 10.3% reported they would not repeat donation if given the choice, and this unwillingness was markedly higher among donors who had reached eGFR < 45 mL/min/1.73 m2 at last follow-up (33.3% vs 6.8%, P = 0.003). Long-term psychosocial outcomes after living kidney donation are overall favorable, but long-term reduced kidney function was associated with donor reluctance to repeat donation, underscoring the importance of rigorous donor selection and careful monitoring of kidney function.
Post-stroke aphasia is a debilitating condition affecting approximately one-third of stroke survivors, profoundly impairing communication, social participation, and quality of life. While speech-language therapy (SLT) remains the standard of care, pharmacological agents such as Cerebrolysin may enhance recovery through neuroprotection and neuroplasticity. We report the case of a 38-year-old female lawyer who developed acute Wernicke's aphasia and right-sided hemiparesis following an ischemic stroke. Despite timely thrombolysis and mechanical thrombectomy, she experienced significant neurological deficits. Early multidisciplinary rehabilitation, combined with a 10-day course of Cerebrolysin, memantine, and sertraline, was associated with substantial improvements in language, motor function, and independence over a three-month period. This case highlights the potential synergistic effect of Cerebrolysin in a young patient with early reperfusion and intensive rehabilitation, including pharmacotherapy and SLT, especially in settings where optimal post-stroke rehabilitation resources may be limited.
This study aimed to evaluate health-related quality of life (HRQoL) trajectories after participation in an online rehabilitation course. A retrospective observational longitudinal study was conducted in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. We analyzed 48 patients who completed a multimodal online rehabilitation course in 2022. The curriculum covered anatomical foundations and practical techniques for voice production, deglutition, respiration, and olfactory recovery. HRQoL was assessed using the EORTC QLQ-C30 instrument at baseline (T0) and annually for 3 years (T1, T2, T3). All scores were linearly transformed to a 0-100 scale. Five patients were censored due to mortality during follow-up. Longitudinal exploratory analyses were performed using repeated-measures comparisons where appropriate. Among the 43 survivors at 3 years, clinically relevant longitudinal improvements were observed in global health status/QoL (from 58.4 ± 18.2 to 85.7 ± 9.8, +27.3 points), physical functioning (+20.9 points), role functioning (+22.5 points), and social functioning (+19.5 points). Symptom burden decreased markedly, particularly fatigue (-22.5 points), dyspnea (-22.7 points), and pain (-17.3 points). Patients with TEVP (tracheoesophageal voice prosthesis) complications (n = 3), defined as an exploratory group, tended to have less favorable recovery trajectories and lower global QoL scores at 3 years compared to those without complications (P = 0.012). The most pronounced improvements occurred within the first post-intervention year and remained stable thereafter. Patients participating in the online rehabilitation program demonstrated sustained improvements in HRQoL over the follow-up period; however, the absence of a control group precludes causal inference.
The successful outcome of endodontic therapy is intrinsically linked to a comprehensive understanding of root canal anatomy and its frequent variations. The objective of this study was to evaluate the root and root canal morphology of permanent maxillary and mandibular canines in a Saudi subpopulation from the Al-Baha region using cone-beam computed tomography (CBCT), specifically investigating the prevalence of Vertucci classifications and canal shape variations across different root levels. This retrospective study analyzed 120 CBCT scans of permanent canines. Internal anatomy was categorized according to Vertucci's classification, and cross-sectional canal shapes were assessed at the cervical, middle, and apical thirds using a standardized 10-point scale. Data were analyzed using Chi-square tests and multivariate logistic regression to assess statistical significance (P < 0.05) by gender and dental arch. All examined teeth were single-rooted. While Vertucci Class I was the most prevalent configuration overall, mandibular canines exhibited significantly greater morphological complexity in the middle third than maxillary canines (P = 0.016), including an 8.5% prevalence of Class III configurations. Morphologically, the most frequent transition in canal shape was from oval at the cervical level to circular at the apical third. This CBCT-based analysis demonstrates that, although single canals predominate, mandibular canines in this subpopulation exhibit significant internal complexity and anatomical variation. These findings underscore the necessity for clinicians to utilize advanced imaging and adapt disinfection protocols to address the specific morphological transitions-such as oval-to-circular shapes and Class III configurations-identified in the mandibular arch to improve endodontic outcomes.
Primary axillary hyperhidrosis (PAH) markedly impairs psychosocial well-being and daily functioning. Botulinum toxin type A (BoNT-A) is widely used, both on- and off-label, to suppress eccrine sweating through presynaptic inhibition of acetylcholine release and temporary chemodenervation of cholinergic sympathetic fibers. This narrative review synthesizes published clinical evidence between 2000 and January 2025 regarding the efficacy, durability, safety, and quality-of-life outcomes of BoNT-A for PAH, with comparative consideration of toxin formulations, injection techniques, and device-based alternatives. Evidence from randomized trials, prospective cohorts, long-term observational studies, and meta-analyses consistently demonstrates that intradermal BoNT-A achieves substantial axillary sweat reduction, often exceeding 50-80%, with improvement of at least two grades on the Hyperhidrosis Disease Severity Scale and meaningful reductions in Dermatology Life Quality Index scores. Treatment effects typically persist for approximately 4-7 months per cycle and are associated with predominantly mild, localized adverse events. Comparative data indicate similar efficacy among onabotulinumtoxinA, incobotulinumtoxinA, and abobotulinumtoxinA when equivalent dosing and standardized mapping techniques are applied. Injection strategy, particularly multi-point intradermal delivery guided by starch-iodine mapping, influences coverage and durability. Energy-based modalities-including microwave thermolysis and fractional microneedle radiofrequency-reduce sweating via device-mediated thermal targeting of eccrine glands and show variable comparative outcomes versus intradermal BoNT-A in durability, downtime, and cost. Overall, BoNT-A remains a well-supported first-line injectable therapy for PAH refractory to topical treatment, while further head-to-head and cost-effectiveness studies remain warranted.
Breast-conserving surgery (BCS) is widely accepted as a standard surgical approach in early-stage breast cancer. However, postoperative complications such as pain and seroma formation remain frequent and may negatively affect quality of life. The potential benefits of supportive bra use in the postoperative period have been suggested but remain insufficiently investigated. This single-center retrospective study included 128 female patients who underwent upfront BCS. All patients were advised to wear a supportive bra for at least 16 hours daily for 3 months postoperatively. Patients were categorized into two groups: regular supportive bra users (n = 74) and non-users (n = 54). Pain was assessed using the Visual Analog Scale (VAS) at postoperative week 1, month 1, month 6, and year 1. Seroma was evaluated using clinical and ultrasonographic assessments at 1 year. Statistical analyses were performed using nonparametric tests. Supportive bra users demonstrated significantly lower VAS scores at week 1, month 1, and month 6 (P = 0.001 for all comparisons). No significant difference was observed at year 1 (P = 0.052). At 1 year, the absence of seroma was significantly higher among supportive bra users (32.4%) than among non-users (18.5%) (P = 0.025). Regular use of a supportive bra after BCS was associated with significantly reduced postoperative pain and improved long-term seroma resolution. Given its non-invasive nature and low cost, supportive bra use may represent a simple and effective strategy to enhance postoperative recovery and patient comfort.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for hematological malignancies, but it is associated with substantial gut microbial dysbiosis linked to graft-versus-host disease, infections, and transplant-related mortality. The conditioning regimen represents the first major iatrogenic insult delivered within the transplant pathway, but its specific contribution to microbiota injury, independent of subsequent aplasia, antibiotic exposure, and mucositis, remains incompletely characterized. We conducted a prospective, single-center, observational longitudinal study at Fundeni Clinical Institute between August 2024 and February 2025, analyzing paired stool samples collected before conditioning (T0) and on the day of stem cell infusion (T1) from 47 adult allo-HSCT recipients. Microbial diversity was assessed using 16S rRNA gene sequencing (V4-V5 region), with the Shannon diversity index as the primary outcome. Statistical analyses were performed using SPSS, including Wilcoxon signed-rank tests for paired comparisons, Mann-Whitney U tests for between-group differences, and Kruskal-Wallis H tests. Shannon diversity decreased substantially between T0 and T1 (median 4.91 vs. 3.51; Wilcoxon P < 0.001; effect size r = 0.62), with 37 of 47 patients (78.7%) showing decline. This conditioning-induced injury was reproducible across three stratification dimensions: agent type (chemotherapy vs. TBI-containing; P = 0.67), intensity (RIC vs. MAC; P = 0.92), and number of cytotoxic agents (2 vs. 3; P = 0.54), with statistically significant within-subgroup decline observed in the four most represented regimens. Beta diversity analysis revealed a significant shift in community composition (PERMANOVA P < 0.001) without differential dispersion. Conditioning produces a substantial, biologically coherent microbiota injury before aplasia-associated factors come into play, but further studies on large cohorts are needed.
The prescription of physical exercise and the individualization of cardiovascular rehabilitation (CVR) programs after acute myocardial infarction (MI) are based on identifying the degree of patients' deconditioning to physical effort. This bicentric, prospective, longitudinal, interventional, non-randomized, pilot study included 44 patients with acute MI who underwent at least eight sessions of moderate-intensity continuous training (MICT) on a sensorized ergometer bicycle. The main aim of the study was to determine whether energy consumption and metabolic equivalents (METs) improved during MICT sessions within the RCV program. The average energy consumption increased progressively from 223.8 ± 125.97 kJ to 407.91 ± 189.87 kJ (P < 0.001), with significant differences starting with moment III to moment VIII, an evolution also reflected by the METs values, which increased from 3.47 ± 1.12 to 4.71 ± 1.39, becoming significant starting with moment III, the statistical significance being consolidated starting with moment IV in the final model. Male gender and maximum heart rate (max HR) were positively associated with both energy consumption and MET values. Left ventricular ejection fraction (LVEF) was significantly associated only with energy consumption (β = 4.52; P = 0.003), while for METs it showed only a tendency toward significance (β = 0.03; P = 0.064). Systolic blood pressure (SBP) was significantly associated only with METs (β = 0.01; P < 0.001). Interindividual variability was significant for both energy consumption and METs, with intraclass correlation coefficients (ICC) of 0.77 and 0.74, respectively. The increase in energy efficiency observed within the program suggests that patients presented a favorable cardiovascular adaptation to exercise and, implicitly, an improvement in both the level and efficiency of physical effort.
Polycystic ovarian syndrome (PCOS) is by far the most prevalent metabolic disease affecting women during their reproductive life. Obesity is a frequently associated manifestation of polycystic ovary syndrome. Central body fat accumulation has been associated with the production of a variety of cytokines associated with low-grade inflammation in polycystic ovary syndrome. This study aimed to evaluate the effect of metformin and cabergoline, each alone and in combination, on several immune markers in women with hyperprolactinemia. The three-arm interventional study included 75 women with PCOS according to the Rotterdam criteria. They were categorized into three groups: those given metformin alone, those given cabergoline alone, and those given combined agents. Baseline and follow-up characteristics included immune markers such as anti-glutamic acid decarboxylase (anti-GAD) antibodies, gonadotropin-releasing hormone (GnRH) antibodies, and interleukin-18 (IL-18). It was observed that the use of either drug alone resulted in no significant change in the level of anti-GAD; however, combined use of the two drugs resulted in a significant reduction in the level, indicating that these two drugs acted synergistically. It was observed that the combined use of either drug resulted in a more significant reduction of GnRH antibody level. It was observed that the combined use of either drug resulted in a more significant reduction of IL-18 level (P <0.001). Metformin and cabergoline are efficient, act synergistically, and are safe when used in combination, reducing IL-8 levels and autoantibodies to GAD and GnRH in women with PCOS.
Seasonal variation influences the transmission dynamics of communicable diseases, yet limited evidence describes these patterns in the Eastern Province of Saudi Arabia. This retrospective study analyzed surveillance data from Johns Hopkins Aramco Healthcare (JHAH) over 6 years (2019-2024) to describe temporal and monthly patterns in nine common notifiable communicable diseases (influenza, salmonellosis, respiratory syncytial virus [RSV], chlamydia, campylobacteriosis, varicella [chickenpox], gonorrhea, scabies, and animal bites) and to describe the epidemic patterns of COVID-19 (analyzed separately from March 2020 to December 2024). The cases were organized by weekly epidemiological data and visualized through monthly line plots, illustrating temporal patterns. Descriptive statistics were used to determine annual totals, peak years and months, and case fatality rates for COVID-19. Results indicated 2,518 cases of nine notifiable diseases, predominantly influenza (686 cases), followed by salmonellosis (592), RSV (293), chlamydia (250), and campylobacter (240). Temporal trends suggestive of seasonal variations were noted, with influenza, RSV, campylobacter, and scabies peaking in winter, while salmonellosis and chickenpox peaked in October. The incidence of chlamydia, gonorrhea, and animal bites was highest in late spring and early summer. From March 2020 to December 2024, there were 36,280 COVID-19 cases and 718 deaths, with three epidemic waves and a decline in monthly cases post-2023. This exploratory study underscores the potential association of climatic and behavioral factors with disease transmission and provides preliminary observations to support public health strategies, including vaccination timing, surveillance, and further research into predictive modeling.
Healthcare-associated infections represent a major public health problem, significantly impacting patient safety and the quality of medical care. Beyond their clinical and epidemiological implications, the prevention of these infections raises important ethical issues. Healthcare professionals have both a professional and moral responsibility to adopt all necessary measures to reduce the risk of healthcare-associated infections. The present article aimed to analyze the ethical dimension of preventing healthcare-associated infections, highlighting the role of fundamental bioethical principles, such as beneficence, non-maleficence, and professional responsibility, in guiding clinical practice. In addition, the responsibilities of healthcare personnel and the ethical dilemmas that may arise in preventing and reporting these infections are discussed. The integration of bioethical principles into medical practice improves the quality of healthcare and strengthens the relationship of trust between patients and healthcare professionals.
Diffuse gliomas are biologically heterogeneous primary brain tumors with variable clinical behavior, and age is a well-recognized prognostic factor; however, integrated real-world data from Eastern European populations remain limited. The aim of this study was to describe how clinical, imaging, molecular, treatment, and survival data co-vary across age groups in a Romanian tertiary neuro-oncology cohort, rather than to identify new biological associations. We conducted a single-center retrospective cohort study of 283 consecutive adult patients with histologically confirmed diffuse gliomas diagnosed between 2021 and 2024, classified according to the WHO 2021 framework. Patients were stratified into three predefined age groups (<40, 40-60, and >60 years), and clinical, histopathological, molecular, preoperative imaging, and treatment variables were compared using Pearson chi-square or Fisher exact tests; recurrence-free survival (RFS) was estimated using the Kaplan-Meier method with log-rank tests. Molecular testing availability varied across the cohort, reflecting progressive adoption of integrated molecular diagnostics. Older patients more frequently harbored IDH-wildtype glioblastoma, more aggressive imaging features, lower Karnofsky Performance Status, and received less intensive multimodal therapy. Unadjusted RFS decreased with advancing age (log-rank P < 0.001); without multivariable adjustment, this reflects the combined effects of age-correlated covariates rather than an independent age effect. This study contributes region-specific real-world evidence from an underrepresented Eastern European setting, where integrated molecular diagnostics were being progressively implemented during the study period.
Bone scintigraphy with bisphosphonate tracers is a cornerstone of noninvasive diagnosis in transthyretin amyloid cardiomyopathy (ATTR-CM). However, methods for estimating the extent and regional distribution of myocardial amyloid burden using single-photon emission computed tomography (SPECT) remain insufficiently validated. This study aimed to evaluate whether global and segmental myocardial radiotracer uptake, assessed by bisphosphonate SPECT, correlates with myocardial amyloid infiltration measured by cardiac magnetic resonance (cMRI)-derived extracellular volume (ECV), and to explore the relationship between these imaging markers and myocardial mechanics. Twenty-seven patients with ATTR-CM who underwent multimodality imaging with bisphosphonate SPECT, cMRI, and transthoracic echocardiography (TTE) between 2017 and 2025 were retrospectively screened. Sixteen patients with complete segmental datasets across all imaging modalities were included in the final analysis. Segmental mixed-effects models were used to account for clustering of myocardial segments within patients. Segmental extent of amyloid burden assessed by SPECT was significantly associated with segmental ECV (β = 0.042, SE = 0.010, t = 4.22), indicating higher radiotracer retention in segments with greater myocardial infiltration. Segmental ECV demonstrated a strong association with impaired longitudinal strain (β = 0.269, SE = 0.043, t = 6.22). In contrast, the direct relationship between radiotracer uptake and longitudinal strain was weaker and not statistically significant (β = 0.016, SE = 0.010, t = 1.60). In combined models, ECV remained independently associated with strain (β = 0.266, SE = 0.045, t = 5.96), whereas radiotracer uptake lost significance (β = 0.003, SE = 0.010, t = 0.29). At the global level, global extent amyloid burden (GEAB) correlated significantly with ECV (β = 0.435, P = 0.018), while the association between GEAB and global longitudinal strain was weaker and nonsignificant (β = 0.092, P = 0.10). Semiquantitative myocardial uptake on bisphosphonate SPECT demonstrates significant concordance with cMRI-derived extracellular volume, supporting its role as a surrogate marker of myocardial amyloid burden. However, myocardial mechanics appear to be more closely associated with extracellular expansion than with radiotracer uptake itself. These findings suggest that current SPECT techniques can estimate myocardial amyloid distribution but remain limited in segmental precision compared with cMRI, likely due to the spatial resolution of conventional SPECT systems and the lack of dedicated processing algorithms for cardiac amyloidosis.
