Compare the radiological characteristics of screening images preceding interval cancers that occurred in women screened with digital breast tomosynthesis (DBT) plus digital mammography (DM) vs. those in women screened with DM alone. From two randomized trials comparing DBT + DM vs. DM, 91 (43 from DBT + DM arm and 48 from DM arm) images preceding interval cancers and 190 (94 and 96, respectively) negative controls were reviewed by three radiologists using only DM screening mammograms and by three different radiologists using all available images, i.e. DBT and DM for the experimental arm and DM for the standard arm. The cancers were classified according to the number of reviewers that found abnormalities, as true negative (negative for all three reviewers), minimal sign (positive for one and negative for two), and false negative (positive for two or three reviewers). In the DM arm, interval cancers were classified as true negative in 29–42

Multidisciplinary management of oncological patients has improved patient outcomes, responding effectively and efficiently to the patient’s health needs. A critical element remains adequate communication, also between radiologist and oncologist, which promotes correct patient management. The Italian Society of Medical Oncology (AIOM) and the Italian Society of Medical and Interventional Radiology (SIRM) have created a working group of representative members to improve not only communication between the two categories but, above all, to allow each member of the different categories to benefit from guidelines of good clinical practice both for filling out the examination request form than the radiological report, and therefore, also allowing clinicians and radiologists who do not work in reference centers, to correctly manage patients in the various phases of their oncological path. A panel of expert oncologists (AIOM members) and radiologists (SIRM members) was established. Multi-round consensus-building Delphi exercise was performed to create a comprehensive structured report (SR) template and a comprehensive requesting model for computed tomography (CT). The requesting model was divided into six sections: (a) oncological family history; (b) relevant clinical data; (c) staging; (d) re-staging; (e) other reason; and (f) follow-up. Regarding CT SR, 3 models were proposed: (1) for staging; (2) for treatment evaluation, and (3) for follow-up. CT SR in staging phase was divided into nine sections: (a) primary tumor; (b) lymph node metastases; (c) liver metastases; (d) lung metastases; (e) brain metastases; (f) other organs (incl. skeleton) metastases; (g) peritoneum; (h) incidental findings and complications; and (i) conclusion. CT SR in treatment evaluation phase was divided into ten sections: (a) primary tumor; (b) lymph node metastases; (c) liver metastases; (d) lung metastases; (e) brain metastases; (f) other organs (incl. skeleton) metastases; (g) peritoneum; (h) treatment-related complication; (i) incidental findings; and (l) conclusion. CT SR in follow-up phase was divided into six sections: (a) appearance of lesions; (b) node metastases; (c) liver lesions; (d) peritoneum; (e) incidental findings and complications; and (f) conclusion. Cronbach’s alpha (Cα) correlation coefficient was used to evaluate internal consistency for each item and the quality analysis according to the average inter-item correlation. Each expert expressed individual comments for each specific template section by using a four-point scale (0 = strongly disagree, 1 = slightly disagree, 2 = modestly agree, 3 = strongly agree). With regard to the 3 CT SR reports, at the first round, all sections achieved ratings above the “good” level. The staging items showing the highest level of agreement among experts in the first round were lung metastases and incidental findings and complications. For treatment evaluation, the items with the highest agreement were treatment-related complication and incidental findings. For follow-up, the items with the highest agreement were appearance of lesions and incidental findings and complications. At the first round, Cronbach’s alpha (Cα) correlation coefficients were 0.92, 0.95, and 0.90 for staging, re-staging, and follow-up, respectively. At the second round, all sections achieved ratings at the “excellent” level. Regarding requesting model, at first round, all sections received an overall score equal to or greater than the level defined as “good” (score = 2). The item that showed the highest level of agreement in the first round was the follow-up section, with a mean value of 2.75 ± 0.62. The correlation coefficient, Cronbach’s alpha (Cα), was 0.75. In the second round, for both the CT SR report and the oncologist request template, all elements received “excellent” ratings. During the inter-society agreement, six AIOM members assessed the CT SR model developed by SIRM, while six SIRM members evaluated the CT requesting model proposed by AIOM. In this single Delphi round, all participants assigned the maximum score (3) to every item across all sections. The inter-society collaboration between AIOM and SIRM is a milestone in improving communication between radiologists and oncologists. The CT request and reporting documents meet the needs of quality care even outside of referral centers, and although do not represent an obligation, they can facilitate understanding between the different categories of professionals involved in patient management.

BACKGROUND:Screening with digital breast tomosynthesis (DBT) detects more cancers than with digital mammography (DM), but has small effect, if any, on interval cancer incidence. METHODS:Data were pooled from two randomized trials within the MAITA Consortium, including 100743 women (664 cancers) screened at baseline and 82938 women (550 cancers) followed for cumulative incidence at subsequent round. At baseline, women were randomized to DBT+DM or DM alone; subsequent round used DM only. We compare the histological characteristics of cancers detected in women screened with DBT+DM versus DM alone, both at recruitment and after a negative screening result. No statistical tests are applied, except for interval cancers and cumulative incidence. FINDINGS:At the first round, the detection rate was 50% higher in the DBT arm compared to the DM arm. The overall incidence of interval cancers was similar in the two arms (IRR 0.95 (0.69-1.32)). At the subsequent round, the detection was 14% lower in the DBT arm, but an overall residual 16% excess of cancers remained (IRR 1.16 (1.04-1.30)). The initial increase in detection with DBT was consistent across most tumor types, except for large tumors (≥20 mm), grade 3, HER2-positive and triple-negative cancers. The reduction in detection after the second round was appreciable for large tumors and node-positive disease, but not for aggressive subtypes (hormone receptors (estrogen- and progesterone)-negative, HER2-positive, Ki-67 positive, triple-negative). INTERPRETATION:DBT likely detects tumours that would have presented as larger tumours in later screening rounds, particularly those with intrinsically favorable prognostic features.

To investigate the surgical impact of preoperative breast MRI in patients diagnosed with invasive lobular breast cancer (ILC) in a prospective observational study. The prospective MIPA observational study database was queried for patients aged 18–80 with newly diagnosed unilateral ILC at needle biopsy referred for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) with those who did not (noMRI group) according to nine confounding covariates. Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). A total of 547 women with unilateral needle biopsy-diagnosed ILC were identified (158 noMRI group, 389 MRI group). After patient matching, each group retained 103 patients, for a total of 206 matched patients. For the rate of women having a first-line mastectomy, there was no significant difference between the MRI group (21.4

BACKGROUND AND OBJECTIVES:The objective of this study was to determine, at the time of diagnosis, a CSF and MRI profile of intrathecal compartmentalized inflammation predictive of progression independent of relapse activity (PIRA) in early relapsing-remitting multiple sclerosis (RRMS). METHODS:This five-year prospective study included 80 treatment-naïve patients with RRMS enrolled at time of diagnosis. All patients underwent a lumbar puncture, regular neurologic evaluations including an Expanded Disability Status Scale (EDSS) assessment every 6 months, and an annual 3T brain MRI. PIRA was defined as having a confirmed disability progression independent of relapse activity. CSF levels of 68 inflammatory molecules were evaluated in combination with white matter and cortical lesion number (CLn) and volume, and regional gray matter thickness and volume. RESULTS:During the follow-up, 23 patients with RRMS (28.8%) experienced PIRA. At diagnosis, participants with PIRA were older (44.0 ± 10.7 vs 37.4 ± 12.4, p = 0.017) and with more disability (median EDSS score [interquartile range] of 3 [range 2-4] for PIRA vs 1.5 [range 1-2] for no PIRA group, p < 0.001). Random forest selected LIGHT, CXCL13, sTNFR1, sTNFR2, CCL7, MIF, sIL6Rbeta, IL35, CCL2, and IFNβ as the CSF markers best associated with PIRA. sTNFR1 (hazard ratio [HR] 10.11 [2.61-39.10], p = 0.001), sTNFR2 (HR 5.05 [1.63-15.64], p = 0.005), and LIGHT (HR 1.79 [1.11-2.88], p = 0.018) were predictors of PIRA at regression analysis. Baseline thalamus volume (HR 0.98 [0.97-0.99], p = 0.005), middle frontal gyrus thickness (HR 0.05 [0.01-0.72], p = 0.028), and CLn (HR 1.15 [1.05-1.25], p = 0.003) were MRI predictors of PIRA. DISCUSSION:A specific intrathecal inflammatory profile associated with TNF superfamily markers, CLn, and atrophy of several cortical and deep gray matter regions, assessed at time of diagnosis, is predictive of PIRA in early MS.

In the era of precision medicine, increasing importance is given to machine learning (ML) applications. In breast cancer, advanced analyses, such as the radiomic process, characterise tumours and predict therapy responses. Breast magnetic resonance imaging (MRI) plays a key role in screening, staging, and treatment monitoring. Lesion segmentation on MRI is essential both to assess tumour growth and as a baseline for radiomic feature extraction. Manual segmentation is time-consuming and prone to inter-operator variability, limiting access to large labelled datasets and robust analyses. The use of ML for breast lesion segmentation on MRI has been investigated through a systematic review of PubMed, exploring studies published over the last 10 years. Results are compared in terms of performance, primarily using the Dice score. Early unsupervised methods achieved a mean Dice score of ∼0.75, surpassing traditional supervised methods (∼0.70). In contrast, deep learning (DL) approaches based on U-Net achieved higher average scores of 0.79. Further customised supervised DL approaches reached a mean Dice score of ∼0.83. However, there is still a gap in research on unsupervised DL techniques, which could help reduce bias and human variability. Future work may also explore multiparametric and multitechnique data, integrating more representative samples, including non-mass lesions.

To analyse the impact of preoperative breast MRI on surgical outcomes of patients diagnosed with pure invasive ductal carcinoma (IDC) or IDC with an associated in situ component (IDC + ductal carcinoma in situ [DCIS]) at needle biopsy. Patients aged 18–80 years referred for upfront surgery after a diagnosis of pure IDC or IDC + DCIS at needle biopsy were retrieved from the Multicenter International Prospective Analysis (MIPA) database. In each subgroup, patients who underwent preoperative MRI (MRI groups) were matched 1:1 to those who did not (noMRI groups) according to eight confounding covariates. Surgical outcomes were compared with non-parametric statistics after calculating odds ratios (ORs). Among 1051 patients with IDC + DCIS, 510 were retained after matching (255 in each group): in comparison to the noMRI group, the MRI group had significantly higher rates of first-line mastectomy (13.3

IntroductionMagnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy of the ventralis intermediate (Vim) nucleus is an “incisionless” treatment for medically refractory essential tremor (ET). We present data on 49 consecutive cases of MRgFUS Vim thalamotomy followed-up for 3 years and review the literature on studies with longer follow-up data.MethodsA retrospective chart review of patients who underwent MRgFUS thalamotomy (January 2018–December 2020) at our institution was performed. Clinical Rating Scale for Tremor (CRST) and Quality of Life in Essential Tremor (QUEST) scores were obtained pre-operatively and at each follow-up with an assessment of side effects. Patients had post-operative magnetic resonance imaging within 24 h and at 1 month to figure out lesion location, size, and extent. The results of studies with follow-up ≥3 years were summarized through a literature review.ResultsThe CRST total (baseline: 58.6 ± 17.1, 3-year: 40.8 ± 18.0) and subscale scores (A + B, baseline: 23.5 ± 6.3, 3-year: 12.8 ± 7.9; C, baseline: 12.7 ± 4.3, 3-year: 5.8 ± 3.9) and the QUEST score (baseline: 38.0 ± 14.8, 3-year: 18.7 ± 13.3) showed significant improvement that was stable during the 3-year follow-up. Three patients reported tremor recurrence and two were satisfactorily retreated. Side effects were reported by 44% of patients (severe: 4%, mild and transient: 40%). The improvement in tremor and quality of life in our cohort was consistent with the literature.ConclusionWe confirmed the effectiveness and safety of MRgFUS Vim thalamotomy in medically refractory ET up to 3 years.

Hemangiomas, benign vascular masses, occasionally occur in the kidneys, presenting as rare, small, unilateral, and solitary growths. Venous hemangiomas, a renal subtype, are atypical. While clinically nonspecific, they are typically asymptomatic and may be incidentally discovered during unrelated clinical workups. Diagnosing renal hemangioma preoperatively is challenging due to rarity, lacking standard radiographic criteria, and poor differentiation from aggressive renal neoplasms on contrast-enhanced imaging. These tumors commonly follow a benign course, with no documented recurrence. This video article showcases the robot-assisted excision of a renal vein hemangioma, addressing the expertise needed in managing this uncommon condition robotically.

Aim: The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM). Methods: MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two -arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic -2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM. Findings: From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic -2D. Recall was higher in the DBT arm (5.84% versus 4.96%), with differences between centres. With DBT, 0.8/1000 (95% CI 0.3 to 1.3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2.6/1000 (95% CI 1.7 to 3.6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic -2D. No learning curve was appreciable. Detection of cancers >= 20 mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple -negative was similar in the two arms. Interpretation: Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for longterm follow-up results on the impact of advanced cancer incidence.

PURPOSE:We present a comprehensive investigation into the organizational, social, and ethical impact of implementing digital breast tomosynthesis (DBT) as a primary test for breast cancer screening in Italy. The analyses aimed to assess the feasibility of DBT specifically for all women aged 45-74, women aged 45-49 only, or those with dense breasts only. METHODS:Questions were framed according to the European Network of Health Technology Assessment (EuNetHTA) Screening Core Model to produce evidence for the resources, equity, acceptability, and feasibility domains of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) decision framework. The study integrated evidence from the literature, the MAITA DBT trials, and Italian pilot programs. Structured interviews, surveys, and systematic reviews were conducted to gather data on organizational impact, acceptability among women, reading and acquisition times, and the technical requirements of DBT in screening. RESULTS:Implementing DBT could significantly affect the screening program, primarily due to increased reading times and the need for additional human resources (radiologists and radiographers). Participation rates in DBT screening were similar, if not better, to those observed with standard digital mammography, indicating good acceptability among women. The study also highlighted the necessity for specific training for radiographers. The interviewed key persons unanimously considered feasible tailored screening strategies based on breast density or age, but they require effective communication with the target population. CONCLUSIONS:An increase in radiologists' and radiographers' workload limits the feasibility of DBT screening. Tailored screening strategies may maximize the benefits of DBT while mitigating potential challenges.

Purpose To evaluate the diagnostic role of a dedicated AI software in detecting anomalous breast findings on mammography and tomosynthesis images in the clinical setting, stand-alone and as aid of four readers. Methods A total of 210 patients with complete clinical and radiologic records were retrospectively analyzed. Pathology was used as the reference standard for patients undergoing surgery or biopsy, and a 1-year follow-up was used to confirm no change in the remaining patients. The image evaluation was performed by four readers with different levels of experience (a junior and three senior breast radiologists) using a 5-point Likert scale moving from 1 (definitively no cancer) to 5 (definitively cancer). The positivity of mammograms was assessed on the presence of any breast lesion (masses, architectural distortions, asymmetries, calcifications), including malignant and benign ones. A multi-reader multi-case analysis was performed. A p value < 0.05 was considered statistically significant. Results The stand-alone AI system achieved an accuracy of 71% (69% sensitivity and 73% specificity), which is overall lower than the value achieved by readers without AI. However, with the aid of AI, a significant increase of accuracy ( p value = 0.004) and specificity ( p value = 0.04) was achieved for the less experienced radiologist and a senior one. Conclusion The use of AI software as a second reader for breast lesions assessment could play a crucial role in the clinical setting, by increasing sensitivity and specificity, especially for less experienced radiologists.

Introduction Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration. Aim To compare the effect of OCR and FGL on clinical and MRI endpoints. Methods 95 relapsing–remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated. Results OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (− 0.12% vs − 0.66%; p = 0.002, Cohen’s d = 0.54), lower global cortical thickness change (− 0.45% vs − 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus ( d -range = 0.65–0.71), frontal gyrus ( d -range = 0.47–0.60), cingulate ( d -range = 0.41–0.72), insula ( d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen ( d = 0.35) and thalamus ( d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions. Conclusions When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss.

To investigate the relationship between a set of prostate-urethral complex (PUC) measurements and incontinence after robot-assisted radical prostatectomy (RARP). The study included data from patients undergoing RARP performed by 2 expert surgeons between 2019 and 2022, with data about preoperative magnetic resonance imaging (MRI) and functional follow-up. Continence status was assessed according to a stringent definition (no PADS used). MRIs were evaluated to calculate prostatic urethral length, membranous urethral length, membranous urethral width, levator ani thickness, and prostate shape. The association of PUC measurements with continence after RARP was studied. Secondarily, we evaluated whether pre-determined cut-off values of PUC measurements could be associated with time to continence. Cumulative hazard incidence analysis was performed by the Nelson-Aalen hazard function. Cumulative incidence hazard curves were built; the Peto-Peto test was used to evaluate the difference among the curves. 366 patients were included. At the 12-month follow-up, 333 patients (90.1

BACKGROUND:Drug-resistant epilepsy (DRE) secondary to hypothalamic hamartoma (HH) often requires surgical resection or stereotactic radiosurgery, which frequently fail to provide satisfactory outcomes and are associated with severe side effects. Magnetic resonance-guided focused ultrasound (MRgFUS) may represent a minimally invasive surgical approach to HH by offering precise thermal ablation of sub-millimetric brain targets while sparing surrounding structures. METHODS:We present the case of a 19-year-old man with HH-associated DRE, who was successfully treated with MRgFUS. The procedure resulted in effective ablation of the hypothalamic interface of the HH, disconnecting the epileptogenic lesion from the surrounding brain tissue. We also reviewed the literature on MRgFUS for DRE. RESULTS:The patient experienced a complete resolution of seizures and significant improvements in social and occupational functioning over an 18-month follow-up period. No neurological, cognitive, or endocrinological adverse effects were observed. CONCLUSION:Our case report and literature review suggest that MRgFUS may achieve adequate seizure control in DRE associated with HH without adverse effects. While MRgFUS shows promise for other forms of DRE, data remain preliminary, and some safety concerns persist. Further studies with long-term follow-up are warranted to better support the use of MRgFUS in DRE.

This study quantifies the impact on budget and cost per health benefit of implementing digital breast tomosynthesis (DBT) in place of digital mammography (DM) for breast cancer screening among asymptomatic women in Italy. A budget impact analysis and a cost consequence analysis were conducted using parameters from the MAITA project and literature. The study considered four scenarios for DBT implementation, i.e., DBT for all women, DBT for women aged 45–49 years, DBT based on breast density (BI-RADS C + D or D only), and compared these to the current DM screening. Healthcare provider's perspective was adopted, including screening, diagnosis, and cancer treatment costs. Introducing DBT for all women would increase overall screening costs by 20

•Despite the significance of oncoplastic procedure, an italian database is lacking.•Senonetwork established a multidisciplinary survey to assess their safety and efficacy.•Reconstructive outcomes were positive across low and high-volume centers.•After mastectomy, implant-based techniques are common. DTI reconstruction is advantageuos.•This contributes to the global understanding of effective strategies against breast cancer.

BACKGROUND AND OBJECTIVES:Cognitive impairment (CI) in multiple sclerosis (MS) is frequent and determined by a complex interplay between inflammatory and neurodegenerative processes. We aimed to investigate whether CSF parvalbumin (PVALB), measured at the time of diagnosis, may have a prognostic role in patients with MS. METHODS:In this cohort study, CSF analysis of PVALB and Nf-L levels was performed on all patients at diagnosis (T0) and combined with physical, cognitive, and MRI assessment after an average of 4 years of follow-up (T4) from diagnosis. Cognitive performance was evaluated with a comprehensive neuropsychologic battery: both global (cognitively normal, CN, mildly CI, mCI, and severely CI, sCI) and domain cognitive status (normal/impaired in memory, attention/information processing speed, and executive functions) were considered. Cortical thickness and gray matter volume data were acquired using 3T MRI scanner. RESULTS:A total of 72 patients with MS were included. At diagnosis, PVALB levels were higher in those patients who showed a worsening physical disability after 4 years of follow-up (p = 0.011). CSF PVALB levels were higher in sCI patients than in CN (p = 0.033). Moreover, higher PVALB levels significantly correlated with worse global cognitive (p = 0.024) and memory functioning (p = 0.044). A preliminary clinical threshold for PVALB levels at diagnosis was proposed (2.57 ng/mL), which maximizes the risk of showing CI (in particular, sCI) at follow-up, with a sensitivity of 91% (specificity 30%). No significant results were found for these associations with Nf-L. In addition, patients with higher levels of PVALB at diagnosis showed higher cognitive (p = 0.024) and global fatigue (p = 0.043) at follow-up. Finally, higher PVALB levels also correlated significantly with more pronounced CTh/volume at T4 in the inferior frontal gyrus (p = 0.044), postcentral gyrus (p = 0.025), frontal pole (p = 0.042), transverse temporal gyrus (p = 0.008), and cerebellar cortex (p = 0.041) and higher atrophy (change T0-T4) in the right thalamus (p = 0.038), pericalcarine cortex (p = 0.009), lingual gyrus (p = 0.045), and medial frontal gyrus (p = 0.028). DISCUSSION:The significant association found between parvalbumin levels in the CSF at diagnosis and cognitive, clinical, and neuroradiologic worsening after 4 years of follow-up support the idea that parvalbumin, in addition to Nf-L, might represent a new potential prognostic biomarker, reflecting MS neurodegenerative processes occurring since early disease stages.

Background: Many efforts have been made to improve accuracy and sensitivity in diagnosing chronic pancreatitis (CP), obtaining quantitative assessments related to functional data. Our purpose was to correlate a computer-assisted analysis of pancreatic morphology, focusing on glandular margins, with exocrine function—measured by fecal elastase values—in chronic pancreatitis patients. Methods: We retrospectively reviewed chronic pancreatitis patients who underwent fecal elastase assessment and abdominal MRI in our institute within 1 year. We identified 123 patients divided into three groups based on the fecal elastase value: group A with fecal elastase > 200 μg/g; group B with fecal elastase between 100 and 200 μg/g; and group C with fecal elastase < 100 μg/g. Computer-assisted quantitative edge analysis of pancreatic margins was made on non-contrast-enhanced water-only Dixon T1-weighted images, obtaining the pancreatic margin score (PMS). PMS values were compared across groups using a Kruskal–Wallis test and the correlation between PMS and fecal elastase values was tested with the Spearman’s test. Results: A significant difference in PMS was observed between the three groups (p < 0.0001), with a significant correlation between PMS and elastase values (r = 0.6080). Conclusions: Quantitative edge analysis may stratify chronic pancreatitis patients according to the degree of exocrine insufficiency, potentially contributing to the morphological and functional staging of this pathology.

This study aims to compare a relatively novel three-dimensional rendering called Path Tracing (PT) to the Volume Rendering technique (VR) in the post-surgical assessment of head and neck oncologic surgery followed by bone flap reconstruction. This retrospective study included 39 oncologic patients who underwent head and neck surgery with free bone flap reconstructions. All exams were acquired using a 64 Multi-Detector CT (MDCT). PT and VR images were created on a dedicated workstation. Five readers, with different expertise in bone flap reconstructive surgery, independently reviewed the images (two radiologists, one head and neck surgeon and two otorhinolaryngologists, respectively). Every observer evaluated the images according to a 5-point Likert scale. The parameters assessed were image quality, anatomical accuracy, bone flap evaluation, and metal artefact. Mean and median values for all the parameters across the observer were calculated. The scores of both reconstruction methods were compared using a Wilcoxon matched-pairs signed rank test. Inter-reader agreement was calculated using Spearman's rank correlation coefficient. PT was considered significantly superior to VR 3D reconstructions by all readers (p < 0.05). Inter-reader agreement was moderate to strong across four out of five readers. The agreement was stronger with PT images compared to VR images. In conclusion, PT reconstructions are significantly better than VR ones. Although they did not modify patient outcomes, they may improve the post-surgical evaluation of bone-free flap reconstructions following major head and neck surgery.