Ultra-high-resolution propagation-based synchrotron phase-contrast CT is an emerging technique for lung imaging. However, its feasibility and diagnostic potential at radiation doses comparable to those used in standard clinical procedures has yet to be established. This study aims to evaluate the performance of phase-contrast CT in comparison with state-of-the-art high-resolution multislice CT and bronchoscopy, and to validate its diagnostic accuracy histologically using porcine and, for the first time, human lung specimens. Phase-contrast CT experiments were conducted at the Italian synchrotron using lung specimens mounted in a custom-made anthropomorphic chest phantom. Imaging utilized two photon-counting detectors under various acquisition settings, followed by artificial intelligence-based denoising. Sequential imaging by phase-contrast CT, multislice CT, and bronchoscopy was performed prior to formaldehyde vapor fixation and histological dissection. Image quality was assessed quantitatively (contrast-to-noise ratio, edge sharpness, power spectra) and qualitatively via radiological scoring across 14 criteria. Phase-contrast CT achieved effective pixel sizes of 0.067 mm (Hydra detector) and 0.038 mm (LAMBDA detector), at radiation doses near full-dose multislice CT (≈ 12 mGy). Denoising improved contrast without major loss of edge sharpness. Radiological scoring showed phase-contrast CT outperformed multislice CT in visualizing peripheral airways and fine parenchymal structures. Histological validation confirmed imaging accuracy. Limitations from source spot size (≈ 200 μm) were noted but did not prevent significant diagnostic improvements. Phase-contrast CT, combined with artificial intelligence-based denoising, offers detailed, non-invasive imaging of lung microstructures at clinically relevant radiation doses. It complements multislice CT, holds potential for clinical adoption in advanced pulmonary diagnostics, and may reduce reliance on invasive biopsies.

ABSTRACT Background Swallowing dysfunction—dysphagia—is a frequent and debilitating symptom in neuromuscular disorders, leading to malnutrition, cachexia, aspiration pneumonia, and death. Identification of the underlying pathophysiological mechanisms is important for diagnosis and treatment. As standard assessments have limitations, novel imaging techniques are needed. We here studied the utility of real‐time MRI and quantitative muscle ultrasound for characterizing dysphagia in two different neuromuscular disorders. Methods This prospective cohort study included 18 patients with inclusion body myositis (IBM, 33% female, age 68.9 ± 7.7 years) and 13 with oculopharyngeal muscular dystrophy (OPMD, 62% female, age 55.9 ± 7.0 years) from two European Neuromuscular research centers (Nijmegen, NL; Göttingen, DE). Swallowing function was studied using real‐time MRI (RT‐MRI), FEES (flexible endoscopic evaluation of swallowing), and clinical assessments. T1‐mapping and quantitative muscle ultrasound (QMUS) were used to analyse tissue properties in swallowing muscles. Outcomes were compared between the two muscle diseases. RT‐MRI values were also compared with 22 age‐ and sex‐matched non‐myopathic controls. Results RT‐MRI revealed significantly prolonged oral transit times in OPMD vs. controls (difference between means = 581.2 ms, 95% CI 225.9–936.4, p = 0.002). Pharyngeal transit time was significantly prolonged in IBM vs. controls (difference between means = 1132.8 ms, 95% CI 482.2–1783, p = 0.001). A cricopharyngeal bar as a well‐established morphological indicator of dysphagia was identified in 80% of patients with IBM compared with 53% in OPMD. Fatty degeneration of the tongue in OPMD significantly correlated between MRI‐T1 values and ultrasound echogenicity (Spearman's ρ = −0.52, p = 0.005). ROC revealed excellent discrimination between diseases by combining RT‐MRI, T1‐mapping and QMUS (AUC = 0.95, 95% CI 0.86–1.00), while FEES and clinical assessments failed to differentiate specific patterns of dysphagia. Conclusions This study supports the value of novel MRI and ultrasound techniques for clinical use by identifying the pathophysiology and severity of impaired swallowing. Differentiating the phenotypes of dysphagia can aid in the diagnosis and treatment of affected patients. RT‐MRI and QMUS may serve as outcome measures for swallowing in clinical trials.

Background and study aims:The over-the-scope (OTS) clip system is an established tool for endoscopic management of gastrointestinal bleeding, perforations, fistulas, and, in its modified form as the full-thickness resection device (FTRD), for resection of gastrointestinal lesions. In selected cases, clip removal is required. Conventional techniques often demand costly devices and may be time-consuming. This study evaluated a novel, simple technique for endoscopic removal of OTS and FTRD clips using an endoloop, focusing on feasibility and safety. Patients and methods:This prospective single-center study included patients who had undergone OTS or FTRD clip placement and required clip removal between March 2021 and October 2024. The removal procedure involved positioning an endoloop underneath the clip. Follow-up endoscopy within 6 months assessed clip detachment. The primary endpoint was the success rate for clip removal; the secondary endpoint was incidence of adverse events (AEs). Results:A total of 18 patients underwent endoloop-assisted removal of OTS (50%, 9/18) or FTRD (50%, 9/18) clips. Endoloop placement was performed at a median of 94 days (range: 27-472) after OTS clip placement and 97 days (range: 0-274) after EFTR. Follow-up endoscopy confirmed clip detachment after a median of 107 days (range: 33-220) for OTS and 114 days (range: 5-203) for FTRD clips. Clip removal was successful in all patients (100%), with no AEs observed. Conclusions:Endoloop-assisted removal of OTS and FTRD clips appears to be effective and safe, representing an addition to current options for endoscopic clip removal.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with prognosis strongly influenced by the presence of lymph node metastasis (LNM). However, preoperative LNM assessment from computed tomography (CT) is limited by low sensitivity, high inter-observer variability, and substantial heterogeneity across imaging protocols. This retrospective multi-center study (546 patients from three institutions) introduces a privacy-preserving deep learning framework that integrates large-scale CT foundation model pre-training with heterogeneity-aware federated optimization to improve LNM detection in PDAC. A CT Vision Foundation Model, pre-trained on 148,000 volumetric CT scans using contrastive self-supervised learning, is fine-tuned to generate transferable 3D representations for patient-level LNM classification. To enable decentralized model training while mitigating inter-institutional variability, we extend federated aggregation to jointly account for label-distribution discrepancies and representation-level divergence across clients. The centralized model achieved a balanced accuracy of 0.601 and a diagnostic odds ratio (DOR) of 3.45, outperforming classical machine learning baselines and prior PDAC LNM approaches. Under federated settings, the proposed heterogeneity-aware strategy consistently outperformed standard FedAvg, recovering a substantial proportion of the centralized model’s performance while preserving strict data privacy. In particular, it improved balanced accuracy by 12.6% over FedAvg and demonstrated superior discriminative ability across all participating cohorts. These findings indicate that combining foundation model pre-training with discrepancy-aware federated learning enhances generalization, robustness, and clinical relevance for multi-center PDAC LNM detection. The proposed framework offers a scalable and privacy-preserving pathway for deploying deep learning models across distributed healthcare systems.

Background:Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms that may cause insulin-independent hypoglycaemia (Doege-Potter-syndrome). Although surgical resection is the standard treatment, non-surgical options may be required for elderly or multimorbid patients. Case Presentation:An 82-year-old woman presented with severe nocturnal hypoglycaemia (<40mg/dl) and progressive weakness. Imaging revealed a large hypervascular retroperitoneal mass. Laboratory findings showed low insulin and C-peptide levels with an IGF-II/IGF-I ratio of 9.3, indicating paraneoplastic hypoglycaemia. Biopsy demonstrated low-grade malignant SFT with STAT6 and CD34 positivity. Because of advanced age and comorbidities, dexamethasone (8mg/day) was initiated, followed by two selective transarterial embolizations over 6 months. Hypoglycaemia resolved rapidly, allowing dexamethasone reducing to 1.5mg/day. At 9-month follow-up, only rare hypoglycaemic episodes remained and were managed with regular meals and low-dose dexamethasone. Conclusion:Combined glucocorticoid therapy and selective embolization may provide sustained glycaemic control in elderly patients with retroperitoneal SFT and Doege-Potter syndrome when surgery is not feasible.

Severe trauma is a frequent cause of death worldwide, especially among younger patients and predominantly due to blunt abdominal trauma. While the liver is often affected, pancreatic injuries are rare. The initial diagnostics include the medical history, physical examination, laboratory tests and the focused assessment with sonography for trauma (FAST). The estimation of hemodynamic stability is decisive. Emergency laparotomy is indicated for critically ill patients and those with an accumulation of free intraabdominal fluid detected by sonography. Stable or stabilizable patients should undergo triphasic contrast-enhanced computed tomography. This enables classification of the injury pattern according to the injury scoring scale of the American Association for the Surgery of Trauma (AAST) and explicit detection of active bleeding and helps to estimate the extent of the injuries. Nonoperative management (NOM) has become established as the standard treatment. In addition to pure monitoring, special interventions are also used. A surgical approach is necessary in cases of instability, extensive injuries or failure of the NOM. The surgical approach depends on the pattern of injury and is similar to that of elective surgery. In addition to local hemostasis resections are possible. Both NOM and complex surgical treatment should be performed at specialized centers.

Schwere Traumata stellen weltweit eine häufige Todesursache, insbesondere jüngerer Patienten dar. Hierbei überwiegen stumpfe gegenüber penetrierenden Abdominaltraumata. Während die Leber häufig betroffen ist, treten Pankreasverletzungen nur vereinzelt auf. Die initiale Diagnostik umfasst die Anamnese, körperliche Untersuchung, Laboruntersuchungen und die FAST-Sonograpfie(Focused Assessment with Sonography for Trauma). Die Einschätzung der hämodynamischen Stabilität ist entscheidend. Bei instabilen Patienten und sonographisch nachgewiesener intraabdomineller freier Flüssigkeit ist eine Notfalllaparotomie indiziert. Stabile oder stabilisierbare Patienten sollten einer triphasischen Kontrastmittel-Computertomographie zugeführt werden. Diese ermöglicht eine Klassifikation des Verletzungsmusters (Injury Scoring Scale der American Association for the Surgery of Trauma [AAST]) sowie explizit die Erfassung aktiver Blutungen und hilft, das Verletzungsausmaß einzuschätzen. Therapeutisch hat sich ein nichtoperatives Management (NOM) etabliert. Neben der reinen Überwachung kommen hierbei spezielle Interventionen zum Einsatz. Ein operatives Vorgehen ist bei Instabilität, ausgedehnten Verletzungen oder bei Versagen des NOM erforderlich. Das Vorgehen richtet sich nach dem Verletzungsmuster und ähnelt dem der elektiven Chirurgie. Neben lokaler Blutstillung sind Resektionen möglich. Sowohl das NOM als auch die komplexe chirurgische Versorgung sollte an spezialisierten Zentren durchgeführt werden.

Background and study aims:Emergency endoscopic interventions for upper gastrointestinal hemorrhage are frequently hampered by presence of blood clots and food debris. This study aimed to assess whether integration of an additional suction channel (ASC) onto a standard gastroscope enhances efficiency of aspirating clots and viscous fluids. Patients and methods:A 5.3-mm suction catheter was used as an ASC mounted on a 2.8-mm standard gastroscope. Suction efficacy was evaluated using gastroscopes with working channel diameters of 2.8 mm, 3.7 mm, and 6 mm in vitro. Defined volumes of water, fruit yogurt, and coagulated blood were aspirated, and time required for complete evacuation was measured. Each setup was tested with and without the BioVac system. Results:The ASC significantly enhanced suction performance across all test media. Notably, the 2.8-mm gastroscope with ASC outperformed all other configurations in aspirating water and yogurt. For clotted blood, the ASC significantly improved evacuation times compared with all other setups besides 6-mm + BioVac. Conclusions:A standard gastroscope equipped with an ASC significantly enhances suction performance in an in vitro model, outperforming gastroscopes with larger working channels. These findings warrant further validation in an ex vivo model to determine their clinical applicability.

Abstract Background Due to the difference in size between the humeral head and the glenoid, the shoulder joint is prone to instability. Therefore, the reconstruction of the physiological joint morphology is of great importance in shoulder joint preservation and replacement surgery. The aim of this study was to describe physiological reference parameters for the morphology of the glenoid for the first time. Material and methods MRI images of the shoulder joints of 418 patients (mean age: 50.6 years [± 16.3]) were retrospectively analysed in a low-grade osteoarthritic population. The glenoid distance in coronal (GDc) and axial view (GDa), glenoid inclination (GI) and version (GV) as well as scapula neck length (SNL) were measured. Parameters were studied in association for age, gender, side and degeneration grade. Results Mean GDc was 33.4 mm (± 3.6), mean GDa 26.8 mm (± 3.2), mean GI 10.5° (± 6.4), mean GV -0.4 mm (± 5.4) and mean SNL was 33.4 mm (± 4.7). GDa was significant higher in right shoulders (p < 0.001). GDc and GDa showed significant higher mean values in older patients (p < 0.001) and in shoulders with more severe degenerative changes (p < 0.05). While GDc, GDa and SNL were significant larger in male patients (p < 0.001), GI had a higher mean value in female shoulders (p = 0.021). Conclusion Age, gender and shoulder joint degeneration influence changes in the morphological parameters of the glenoid. These findings have to be considered in shoulder diagnostics and surgery. Clinical trial number Not applicable.

The analysis of the liver, including its vessels and lesions, is essential for pre-operative intervention planning. Automated deep learning-based segmentation provides a time-efficient method for consistently localizing and visualizing these structures. However, the integration of deep learning algorithms into clinical practice necessitates thorough testing and validation. It is crucial not only to assess quantitative and volumetric metrics but also to evaluate these algorithms clinically through experienced radiologists and surgeons. In this study, we used an independent test set of 107 computed tomography scans to conduct a multi-user, multi-disciplinary analysis of a deep learning-based segmentation results. Six experienced clinicians-three surgeons, one surgical resident and two radiologists-evaluated the predictions made by the deep learning models. While liver segmentation can be considered largely solved, vessel segmentation still requires improvement. By manually identifying missing lesions (false negatives) as well as accepting and rejecting proposed lesions, performance metrics can be calculated for the lesion segmentation without needing a reference segmentation. Notably, lesion segmentation achieved an F1-score of 0.82 for lesions larger than 1 cm in diameter.

ZusammenfassungDie Übersichtsarbeit „Modalitäten des Stagings und der Diagnostik bei Rektumkarzinom“ soll einen Einblick in die bildgebende Diagnostik bei Patient*innen mit Rektumkarzinom geben.Das Rektumkarzinom ist eine der häufigsten Krebserkrankungen mit einer der höchsten Mortalitätsraten weltweit. Die rechtzeitige Diagnose und Therapie dieses Malignoms hat daher eindeutige sozioökonomische Implikationen.Radiologische Bildgebung spielt bei der Therapieplanung eine entscheidende Rolle. Moderne Schnittbildverfahren werden zur Diagnosestellung und zur Ausbreitungsdiagnostik, dem Staging, eingesetzt.Die Rolle der einzelnen bildgebenden Verfahren im Rahmen der Diagnostik beim Rektumkarzinom wird im Detail und deren Funktion im Allgemeinen erklärt. Ferner werden relevante Neuerungen und Forschungen auf dem Gebiet der Bildgebung präsentiert.Speziell soll im Rahmen dieser Übersichtsarbeit der zunehmende Stellenwert der MRT-gestützten lokalen Ausbreitungsdiagnostik herausgestellt werden. Definierte diagnostische Kriterien auf Basis gängiger Empfehlungen werden erklärt. Es wird gezeigt, dass das lokale Staging mittels MRT bei Erstdiagnose und Verlaufskontrolle die therapierenden Disziplinen beim Festlegen eines Therapieplans unterstützen kann. Im Speziellen soll aufgezeigt werden, wie die MRT dabei die Festlegung eines chirurgischen Vorgehens maßgeblich beeinflussen kann.

The aim of the present study was to determine physiological reference values for the morphology of the patella and to analyse these parameters according to patella position in healthy knee joints. Healthy knee joints of 409 patients (mean age, 52.3 years [± 16.8]) were analysed retrospectively on MRI images for Insall-Salvati index (ISI), sagittal patella thickness (PTS) and patella length (PLS) as well as axial patella thickness (PTA) and patella width (PWA). Differences between patellar diameters were analysed depending on ISI, side, age and gender. Mean PTS was 20.1 mm (± 2.4), PLS 44.0 mm (± 4.4), PTA 21.8 mm (± 2.4) and PWA 44.5 mm (± 4.7). Depending on the vertical patellar position (ISI), all patellar parameters (p < 0.01) showed significant differences between patients with a patella alta, norma and baja. In general, a smaller ISI showed higher measured values for the patellar parameters. There were no significant differences for the laterality. Only PTS showed a significant age difference (p = 0.031). All parameters were significantly larger in male compared to female knees (p < 0.001). Reference parameters for the patella morphology are reported. Concluding from the results, a relationship between vertical patellar position and patellar morphology seems to exist. This finding should be taken into account in diagnostics and therapy of patella disorders.

Schnitzlers syndrome is a rare acquired autoinflammatory disorder. Chronic urticarial rash and monoclonal gammopathy (mainly IgM, rarely IgG [1]) are essential components of the disease. Schnitzlers syndrome can present itself with osseous lesions, often in the distal femur and proximal tibia or in the hip bones. We report a case with uncommon radiological manifestation.