Objective To assess the impact of wearing a brassiere during low-dose chest CT (LDCT) examination on image quality and radiation dose.Methods A comparative study included 87 patients who underwent paired LDCT examinations at the Hospital from February 2022 to July 2024. Each patient underwent a standard LDCT (SLDCT) without a brassiere and a modified LDCT (MLDCT) with a brassiere. Objective image quality was assessed using the standard deviation (SD) in predefined lung regions. Three experienced radiologists compared the image quality subjectively. For comparison of radiation doses between the protocols, we used standard dose indicators including CTDIvol, DLP, and SSDE. Clinical data were collected between February 2022 and July 2024.Results Objectively, no statistically significant differences in SD or radiation dose were observed between MLDCT and SLDCT protocols. Median centering differences between paired scans were minimal (-8.8 mm), ensuring consistent comparisons. Subjective image quality was rated as equivalent or better for MLDCT in most cases, with a high level of interobserver agreement (95.4%).Conclusion Wearing a brassiere during LDCT examinations caused no worsening of image quality or increase in radiation dose. It facilitates easier patient centering. These findings suggest that the modified protocol could be safely implemented in routine clinical practice. Further research could extend these observations to other chest imaging protocols.

Abstract Purpose To analyze the number, location, and clinical significance of new ischemic lesions (NIL) after carotid stenting in patients with guided antiplatelet therapy. To evaluate factors leading to thromboembolic complications and silent ischemia. Secondarily, we compared the incidence of NIL among historical cohorts with guided and standard antiplatelet therapy. Methods We conducted a retrospective analysis of prospectively collected data from 171 patients who underwent carotid stenting in a single center between 2014 and 2023. Magnetic resonance imaging with diffusion-weighted images was performed before and after stenting. We evaluated NIL after the procedure and their dependence on patient demographics, degree of stenosis, instrumentation used, and antiplatelet therapy. The incidence of NIL was compared to three cohorts receiving more potent or guided antiplatelet therapy based on platelet function test (n = 689) and to seven cohorts receiving standard dual antiplatelet therapy with aspirin and clopidogrel (n = 2777), using the meta-analytical approach. Results New ischemic lesions were found in 15.8% of patients (27/171). We recorded five ischemic strokes (2.9%). Most NIL were located in the ipsilateral middle cerebral artery basin (91%), but they also occurred contralaterally or in another basin. Stenosis length ≥ 15 mm (p = 0.012) was shown to be significantly associated with the development of NIL. The incidence of NIL in a center with guided antiplatelet therapy was distinctly lower compared to results of the studies with standard antiplatelet therapy, 15.8% vs. 28.3–51.3%. Conclusion Guided antiplatelet therapy in carotid stenting is safe and shows a lower incidence of new ischemic lesions on MR-DWI compared to results with standard antiplatelet therapy. In this study with guided antiplatelet therapy, NIL were only associated with greater stenosis length.

Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is a radiological biomarker for idiopathic normal pressure hydrocephalus (iNPH). DESH is a subjective measure, based on visual assessments, which may limit its reliability. The aim of this study was to develop and validate a method for the objective quantification of DESH. By using a semiautomatic quantitative method, we calculated quantitative DESH (qDESH), defined as a ratio between CSF volumes at high convexities and Sylvian fissures. The analysis was based on three-dimensional T1-weighted images from 35 subjects with iNPH (mean age 74 yrs; 10 females) and 45 controls (mean age 72 yrs; 13 females). The interrater agreement for qDESH was evaluated by the intraclass correlation coefficient, and qDESH was compared with visual assessments performed by two neuroradiologists. All subjects with iNPH and 13

BACKGROUND:This study aimed to retrospectively evaluate the efficiency, accuracy, technical features, and relationships among the monitored parameters of CT-guided percutaneous biopsies of focal chest wall lesions. METHODOLOGY:A total of 143 percutaneous biopsy procedures for tumors, ranging in size from 15 to 168 mm (median size 43 mm), were performed in patients with focal chest wall lesions over 12 years. Only local anesthesia using trimecaine was sufficient for the procedures. The duration of the intervention never exceeded 20 minutes. Needles 14 G, 16 G, or 18 G were used for the biopsies. Histological results were extended with subtyping in the vast majority of cases. In 91 interventions (63.6%), malignant disease was present in the patients´ medical history. RESULTS:Diagnostic accuracy was achieved in 137 (95.8%) biopsies, while six (4.2%) procedures yielded false-negative histological results later confirmed by surgical excision. Metastatic disease of diverse origins represented the most frequent histological diagnosis (46.2%). Hematologic malignancies were revealed in 29.4% of procedures. Primary tumors were verified in only 13 (9.1%) cases. Complications occurred in 3 (2.1%) procedures, all consisting of minor hemorrhage managed conservatively. CONCLUSION:CT-guided percutaneous core needle biopsy of focal chest wall lesions demonstrated high diagnostic accuracy with a minimal incidence of complications.

Background: Pyogenic spondylodiscitis is a severe spinal infection. Surgery can provide source control, neural decompression, and stability when indicated, but practice varies. We assessed outcomes of surgically treated cases at a tertiary neurosurgical center (2015–2024). Methods: Retrospective cohort of consecutive adults admitted with pyogenic spondylodiscitis to a tertiary neurosurgical center (2015–2024). Surgical and non-surgical cases were recorded; analyses focus on surgically managed patients with whole-cohort descriptors where indicated. Methods: We retrospectively analysed consecutive patients indicated for surgery. Variables included procedure type (decompression alone vs. instrumentation), presence of epidural abscess, reoperation for relapse or new-onset instability, microbiology, length of hospital stay (LOS), early outcomes, and admission clinical status. Results: We included 126 patients (87 men, 69%); mean age 65 years (range 13–91). Surgery was performed in 108 (85.7%): decompression alone in 76/108 (70.4%), instrumented decompression in 21/108 (19.4%), standalone instrumentation in 4/108 (3.7%), and multistage combined procedures in 7/108 (6.5%). Epidural abscess was present at the index operation in 98/108 (90.7%). Relapse, either confirmed intraoperatively or on preoperative MRI occurred in 29/126 (23.0%); reoperation for progressive instability in 17/108 (15.7%). Among patients with confirmed etiology (121/126, 96.0%), the most frequent pathogens were Staphylococcus aureus 69/121 (57.0%), Enterobacterales 18/121 (14.9%), and streptococci 16/121 (13.2%). Mean LOS was 35.3 days (median 27). Multiorgan failure developed in 44/126 (35.0%); in-hospital mortality was 7/126 (5.6%). No implant-related complications were observed. Conclusions: Early surgical source control with decompression without instrumentation was sufficient in most operated cases. When radiographic or intraoperative instability was present, instrumentation appeared safe despite active infection, provided meticulous debridement and pathogen-directed antibiotics were employed. Blood cultures and tissue samples should be taken timely and repeated if needed, as they both provide high diagnostic yield.

OBJECTIVES:Postpartum haemorrhage is the most common cause of mortality among women after childbirth. Therefore, this work aims to highlight the possibility of endovascular treatment of postpartum haemorrhage due to remnants in patients with placenta accreta spectrum disorders (PAS disorders) using selective UAE after failure of the standard management. This procedure is a relatively safe and technically nondemanding, with a low risk of recurrent vaginal bleeding. MATERIALS AND METHODS:This article presents an evaluation of the results of eight patients (age between 19-39 years) who underwent selective transarterial embolisation of uterine arteries from January 2022 to August 2023 at the angio-interventional department of our university hospital center. Based on a multidisciplinary consensus of sonographically detected residues of placenta accreta with typical hypervascularisation, unilateral/bilateral embolisation of the uterine artery was performed with a microcatheter using polyvinyl alcohol embolisation particles, possibly in combination with gelatine foam. RESULTS:There were no periprocedural complications during embolisation, nor were there episodes of repeated bleeding or other postprocedural complications during the follow-up. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularised residual tissue. CONCLUSIONS:Thus far, this procedure has proven to be a safe and relatively technically nondemanding method supplementing the management of symptomatic patients with PAS disorders with a low risk of rebleeding.

Introduction: Systemic targeted therapy options are commonly used in patients with metastatic renal cell carcinoma (mRCC).Histological verification is crucial for this treatment institution. Aim:To evaluate the optimal location for percutaneous CT-guided biopsy in the diagnosis of suspected mRCC.Material and methods: 138 percutaneous biopsy procedures for tumours, ranging in size from 21 -133 mm at the largest diameter (median size 72 mm), were carried out in 134 patients with highly suspected mRCC over a five-year period.The biopsy location was variable, kidney process biopsies were performed in 77 cases (55.8%), while other localizations (retroperitoneum, peritoneal cavity, liver, pelvis, pleural space, lung, mediastinum, chest or abdominal wall and pancreas) were selected in 61 cases (44.2%). Results:In 288 biopsies (97.1%), results were true positive; 4 procedures (2.9%) yielded histologically false negatives, necessitating confirmation through extended rebiopsy.RCC was the most common individual diagnosis (85.5%), with non-RCC histology verified in 14.5% of cases.In total, 32 complications (23.2%) were confirmed, 2 of which were pneumothoraces, 29 were minor bleedings that needed only conservative management, and one case requiring angiography and embolisation for hemorrhage treatment.While no statistically significant relationship between biopsy success and lesion localization (renal vs. other) was found (p = 0.129649), the relationship between complication rate and biopsy localization (renal vs. other) was proven to be statistically significant (p = 0.014867).Conclusions: Lesion localization (renal vs. other) was not relevant to histological accuracy in biopsies performed on patients with suspected mRCC.However, biopsies conducted on lesions outside the kidney had a lower complication rate.

In MS, MRI has an irreplaceable role. The unification of MRI management across different institutions is crucial for maximal use of the potential of this method, i.e., for early and accurate diagnosis with the determination of prognostic markers, early signal of ineffectiveness of therapy or safety problem, but also for availability of adequate care for all patients. At the same time, communication between the radiologist and neurologist and the associated standardization of both the referral form and MRI description are essential. In addition to improving the quality of care for the individual patient, a uniform MRI data format would also lead to the possibility of national data collection. This would allow for structured information for research as well as the use of MRI data in negotiations with healthcare providers. For this purpose under the patronage of the Section of Clinical Neuroimmunology and Liquorology of the Czech Neurological Society, this consensus of the Czech Expert Radiology-Neurology Panel is published based on the international Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) recommendations. It proposes recommendations for a basic and extended diagnostic, monitoring and safety MRI protocol, specifies the frequency of individual examinations, the necessary information on the MRI referral form and presents a standardized description of diagnostic and monitoring MRI in patients with suspected or confirmed diagnosis of MS.

Monitoring and tracking the size and the number of multiple sclerosis (MS) lesions is very important in clinical medicine to understand the course and estimate the progression of this demyelination disease. The lesions could be identified by the experts with brain magnetic resonance imaging (MRI) technology, especially the fluid attenuated inversion recovery sequence (FLAIR), which generates two-dimensional slices sampled from the three-dimensional space with specified slice thickness and increment values. Not every MRI scan, however, could be contiguous nor overlapping due to many reasons, to prevent from a drastic increase in the overall duration of the scans. Particularly, it is very hard to stabilize a child for hours in the same position; therefore, the specialists keep the scan procedure as short as possible, by increasing the slice thickness and more importantly, reducing the number of slices which cause some consistent gaps emerging between the slices and leading to inconclusive results. Given these facts, we propose a novel procedure to overcome this inadequacy by filling the gaps of incremental MRIs based on a Nakagami imaging and a content-based morphing method generating imaginary frames between the genuine MRI slices. Afterwards, the segmented images are reconstructed in three-dimensional space to estimate the lesion volumes for three consecutive scans of one patient. The results are greatly encouraging that we calculated 95.72% as the mean average percentage accuracy (MAPA) with 92.17% dice score (DSC%); while a little sacrifice in DSC% down to 90.35% provided us a better MAPA of 96.44%; while without morphing, the MAPA was calculated using only the binary ground truth (GT) images as 85.97%. As an expert system, the automated framework we presented would be very beneficial for volume estimations in clinics as well as visualizing the lesions and tracking the progression of MS disease.

Multiple sclerosis (MS) is a neurological demyelinating disorder affecting brain and spinal cord by attacking the myelin sheaths of nerves. Estimation of the volumetric changes in MS lesions is a challenging and specialized task which is executed and judged by medical experts. The change in the volume of the lesions provides crucial information on MS progression or regression by comparing the magnetic resonance images (MRI) taken in successive scans. However, visual comparison of the images, even with an expert eye, would not always lead to a conclusive decision nor a consensus on progression or regression. Therefore, we present an automated expert system for estimating MS progression rate by automatic lesion segmentation and volume estimation using two-dimensional MRIs, which is also adaptable to various parameters, slice thickness and increment. A clinical dataset is specially formed for this research which contains three sets of 135 MR images of an MS patient generated within approximately 23- and 6-month periods consecutively with identical device parameters. The lesions are segmented by a novel Rayleigh-Weibull-Fuzzy (RWF) imaging method based on the Nakagami distribution and specialized fuzzy 2-means. Subsequently, the segmentation module is trained to fit the ground truths images created by experts to achieve the highest dice score possible for a total number of 56 images containing lesions, which is found as 93.76 %. Afterwards, several imaginary image sequences are generated by augmented linear and nonlinear morphing for re-segmentation of imaginary lesions by RWF. Finally, we estimated the volumetric change between the first two MRI sequences to adjust the morphing module and to predict the progression rate of the lesions in time. The framework automatically selected the highest accuracy, which is 99.9 % in the training session and estimated the progression rate in the testing phase with 99.69 % accuracy, which are not achievable without augmented morphing methodology. For the first time in the literature, an automated framework could estimate the MS progression rate from the raw MR images, which is also the main innovation of this paper and the outputs would be beneficial for the experts working on this field.

Introduction: Systemic targeted therapy options are commonly used in patients with metastatic renal cell carcinoma (mRCC). Histological verification is crucial for treatment of mRCC. Aim: Our aim was to evaluate an optimal location for percutaneous computed tomography-guided biopsy in a diagnosis of suspected mRCC. Materials and methods: A total of 138 percutaneous biopsies for tumors ranging from 21 to 133 mm in diameter (median, 72 mm) were carried out in 134 patients with suspected mRCC over a 5-year period. The biopsy location was variable, with kidney biopsy performed in 77 cases (55.8%), and other localizations (retroperitoneum, peritoneal cavity, liver, pelvis, pleural space, lung, mediastinum, chest or abdominal wall, and pancreas) in 61 cases (44.2%). Results: As many as 288 biopsies (97.1%), yielded true-positive results, and 4 procedures (2.9%) yielded histologically false-negative results that required confirmation through extended rebiopsy. RCC was the most common individual diagnosis (85.5%), with non-RCC histology verified in 14.5% of cases. In total, 32 complications (23.2%) were confirmed, 2 of which were pneumothoraces, 29 were minor bleeding that needed only conservative management, and 1 case required angiography and embolization for hemorrhage treatment. While no significant relationship between the biopsy success and lesion localization (renal vs other) was found (P = 0.13), the relationship between complication rate and biopsy localization (renal vs other) was significant (P = 0.01). Conclusions: Lesion localization (renal vs other) was not relevant to histological accuracy of the biopsies performed in patients with suspected mRCC. However, the biopsies of lesions outside the kidney had a lower complication rate.

Minimally invasive oxygen-ozone (O2-O3) therapy utilizing the biochemical effects of O2-O3 mixture is commonly used in the treatment of musculoskeletal pain. The literature dealing with O2-O3 therapy of spinal pain focuses mainly on the lumbosacral region. The aim of this review is to evaluate the efficacy of O2-O3 therapy in musculoskeletal pain in the neck region. The Medline (PubMed), SCOPUS, Web of Science, and Google Scholar databases were searched for clinical studies, using the free text terms: ozone, neck, cervical, spine, pain, disc, hernia, nucleolysis, paravertebral, treatment, and various combinations of them. In total, seven studies (two randomized controlled trials and five observational studies) were found. These studies dealt with the intradiscal or intramuscular paravertebral application of O2-O3 mixture in patients with myofascial pain syndrome, cervical disc hernias, and chronic neck pain. All these studies proved a significant decrease in neck pain (evaluated by Visual Analog Scale or Numerical Rating Scale), and most of them showed improvement in functional status (measured by Oswestry Disability Index or Neck Disability Index). In addition, other pain assessment scales and function and quality of life measures (DN4 questionnaire, pain pressure threshold, cervical lateral flexion range of motion, Japanese Orthopedic Association scale, 12- and 36-Item Short Form Surveys, modified MacNab criteria, and analgesic drug intake reduction) were used. Changes in these measurements also mostly supported the efficacy of O2-O3 treatment. No significant complications of the treatment were reported. The available evidence is sparse, but despite this, the O2-O3 treatment of musculoskeletal neck pain can be considered potentially beneficial and relatively safe.