Clinical issues and challenges in imaging of gastrointestinal diseases:A minireview and our experience

Imaging techniques play a crucial role in the modern era of medicine,particularly in gastroenterology.Nowadays,various non-invasive and invasive imaging modalities are being routinely employed to evaluate different gastrointestinal(GI)diseases.However,many instrumental as well as clinical issues are arising in the area of modern GI imaging.This minireview article aims to briefly overview the clinical issues and challenges encountered in imaging GI diseases while highlighting our experience in the field.We also summarize the advances in clinically available diagnostic methods for evaluating different diseases of the GI tract and demonstrate our experience in the area.In conclusion,almost all imaging techniques used in imaging GI diseases can also raise many challenges that necessitate careful consideration and profound expertise in this field.

Future of prostate imaging:Artificial intelligence in assessing prostatic magnetic resonance imaging

Prostate cancer(Pca;adenocarcinoma)is one of the most common cancers in adult males and one of the leading causes of death in both men and women.The diagnosis of Pca requires substantial experience,and even then the lesions can be difficult to detect.Moreover,although the diagnostic approach for this disease has improved significantly with the advent of multiparametric magnetic resonance,that technology has certain unresolved limitations.In recent years artificial intelligence(AI)has been introduced to the field of radiology,providing new software solutions for prostate diagnostics.Precise mapping of the prostate has become possible through AI and this has greatly improved the accuracy of biopsy.AI has also allowed for certain suspicious lesions to be attributed to a given group according to the Prostate Imaging-Reporting&Data System classification.Finally,AI has facilitated the combination of data obtained from clinical,laboratory(prostate-specific antigen),imaging(magnetic resonance),and biopsy examinations,and in this way new regularities can be found which at the moment remain hidden.Further evolution of AI in this field is inevitable and it is almost certain to significantly expand the efficacy,accuracy and efficiency of diagnosis and treatment of Pca.

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following.We focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,etc.Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological disorders.We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

Breast cancer imaging-clinical experience with two-dimensionalshear wave elastography:A retrospective study

BACKGROUND Breast cancer morbidity has been increasing worldwide,but treatments are improving.The therapeutic response depends on the stage at which the disease is diagnosed.Therefore,early diagnosis has never been more essential for successful treatment and a reduction in mortality rates.Radiology plays a pivotal role in cancer detection,and advances in ultrasound(US)palpation have shown promising results for breast cancer imaging.The addition of two-dimensional-shear wave elastography(2D-SWE)US in the routine breast imaging exam can increase early cancer detection and promote better surveillance.AIM To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities.METHODS The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions.All patients underwent mammography,bright mode(B-mode)US,and 2D-SWE followed by US-guided biopsy in two consecutive sessions.RESULTS Combining B-mode and shear wave US imaging with X-ray mammography revealed 100%of the suspicious lesions,resulting in greater sensitivity,specificity,and negative predictive value.The result improves compared to either B-mode or 2D-SWE alone(P=0.02).CONCLUSION Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection.Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Ductal carcinoma in situ within a fibroadenoma:A case report and review of literature

BACKGROUND Fibroadenoma(FA)is the most common tumor found in young women,although it can occur in any age group.Ductal carcinoma in situ(DCIS)that is confined in a FA is rare;it is most frequently reported as an incidental finding.CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancerrelated personal and family histories.The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year.In the current control image study,we found suspicious microcalcification,as a new finding,within one of the nodules.Consequently,a core biopsy of the tumor,which appeared hypoechoic,oval,and circumscribed,was performed.The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion.The patient underwent breastconserving surgery and received radiotherapy as well as endocrine therapy(tamoxifen).CONCLUSION We recommend a multidisciplinary approach for adequate treatment and followup.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Quantitative magnetic resonance imaging of the fetal brain in utero: Methods and applications

Application of modern magnetic resonance imaging(MRI) techniques to the live fetus in utero is a relatively recent endeavor. The relative advantages and disadvantages of clinical MRI relative to the widely used and accepted ultrasonographic approach are the subject of a continuing debate; however the focus of this review is on the even younger field of quantitative MRI as applied to non-invasive studies of fetal brain development. The techniques covered under this header include structural MRI when followed by quan-titative(e.g., volumetric) analysis, as well as quantita-tive analyses of diffusion weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy and functional MRI. The majority of the published work re-viewed here reflects information gathered from normal fetuses scanned during the 3rd trimester, with relatively smaller number of studies of pathological samples including common congenital pathologies such as ven-triculomegaly and viral infection.

Features of primary pancreatic lymphoma:A bi-institutional review with an emphasis on typical and atypical imaging features

BACKGROUND Primary pancreatic lymphoma(PPL)is a rare neoplasm.Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma(PDAC)is important for appropriate management.Unlike PDAC,PPL is highly sensitive to chemotherapy and usually does not require surgery.Therefore,being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment,it will also avoid unnecessary surgical intervention.AIM To evaluate the typical and atypical multi-phasic computed tomography(CT)imaging features of PPL.METHODS A retrospective review was conducted of the clinical,radiological,and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020.Institutional review board approval was obtained for this investigation.The collected data were analyzed for subject demographics,clinical presentation,laboratory values,CT imaging features,and the treatment received.Presence of all CT imaging findings including size,site,morphology and imaging characteristics of PPL such as the presence or absence of nodal,vascular and ductal involvement in these subjects were recorded.Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study.RESULTS Twenty-nine cases of PPL were diagnosed between January 2000 and December 2020(mean age 66 years;13 males/16 females).All twenty-nine subjects were symptomatic but only 4 of the 29 subjects(14%)had B symptoms.Obstructive jaundice occurred in 24%of subjects.Elevated lactate dehydrogenase was seen in 81%of cases,whereas elevated cancer antigen 19-9 levels were present in only 10%of cases for which levels were recorded.The vast majority(90%)of tumors involved the pancreatic head and uncinate process.Mean tumor size was 7.8 cm(range,4.0-13.8 cm).PPL presented homogenous hypoenhancement on CT in 72%of cases.Small volume peripancreatic lymphadenopathy was seen in 28%of subjects.Tumors demonstrated encasement of superior mesenteric vessels in 69%of cases but vascular stenosis or occlusion only manifested in 5 out of the twentynine individuals(17%).Mild pancreatic duct dilatation was also infrequent and seen in only 17%of cases,whereas common bile duct(CBD)dilation was seen in 41%of subjects.Necrosis occurred in 10%of cases.Size did not impact the prevalence of pancreatic and CBD dilation,necrosis,or mesenteric root infiltration(P=0.525,P=0.294,P=0.543,and P=0.097,respectively).Pancreatic atrophy was not present in any of the subjects.CONCLUSION PPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment.In addition to the typical CT findings of PPL,such as homogeneous hypoenhancement,absence of vascular stenosis and occlusion despite encasement,and peripancreatic lymphadenopathy,this study highlighted many less typical findings,including small volume necrosis and pancreatic and bile duct dilation.

Primary Lymphoma of Bone: Imaging Findings to Improve Diagnosis of a Rarely Considered Disease Prior to Biopsy

Objective: Primary lymphoma of bone (PLB) is a rare malignant bone tumor often presenting in the fifth-sixth decades involving appendicular long bones. Published radiological findings indicate that PLB typically presents as a moth-eaten osteolytic lesion with periosteal reaction, while MRI commonly demonstrates marrow infiltration with extraosseous extension. Given rarity and variable appearances, PLB may not be primarily considered prior to biopsy. Our objective was to evaluate preoperative imaging findings in effort to increase awareness and improve a perceived deficiency in preoperative diagnosis. Materials and Methods: Following IRB approval, retrospective review identified 60 patients with newly diagnosed bone lesions proven to represent PLB in accordance with WHO definition. Preoperative radiographs (n = 46), MRI (n = 33) and PET (n = 37) were independently reviewed by two radiologists. At radiography, lesions were classified: purely lytic, mixed, purely sclerotic, or occult;lytic lesions were graded utilizing Lodwick’s classification. At MRI, lesions were defined as focal or infiltrative and the presence or absence of extraosseous disease was recorded. Extraosseous masses were defined as small (1 cm) and subjectively correlated with degree of cortical destruction. At PET, lesions were recorded as FDG-avid or not. Primary radiograph reports when available (n = 33) were reviewed and exact wording of differential considerations was recorded. Results: Radiographs demonstrated mixed (n = 22), lytic (n = 15), and sclerotic (n = 8) appearances;one radiographically occult lesion was seen by MRI. Lytic lesions were graded: IB (n = 3), IC (n = 5), II (n = 4), and III (n = 3);none were IA. At MRI, 30 lesions were infiltrative and 3 were focal;11 were not associated with extraosseous extension, while 22 showed bony disease with small (n = 7) or large (n = 15) soft tissue mass. Of large masses, 13 demonstrated minimal cortical destruction. At PET, 36 demonstrated FDG uptake;one study was technically limited. Review of reports found that only 5 included “lymphoma” as a diagnostic consideration. Conclusion: Contrary to most published data, we suggest that PLB typically demonstrates some degree of osteosclerosis, often a mixed pattern of sclerosis and lucency;purely lytic lesions may be less common. Similar to existing reports, MRI commonly demonstrates marrow infiltration with extraosseous extension of disease, typically a large soft tissue mass with disproportionate (minimal) cortical destruction. Familiarity with these findings should improve preoperative consideration of PLB in the appropriate clinical scenario when a new osteoblastic lesion is identified.

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation.Computed tomography(CT)and magnetic resonance imaging(MRI)are currently the imaging modalities of choice in pre-operative evaluation.These cross-sec-tional imaging techniques can reveal the vascular and biliary anatomy,assess the hepatic parenchyma and perform volumetric analysis.Knowledge of the broad indications and contraindications to qualify as a recipi-ent for LDLT is essential for the radiologist reporting scans in a pre-transplant patient.Similarly,awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations.CT and MRI have largely replaced invasive techniques such as catheter angiography,percutaneous cholan-giography and endoscopic retrograde cholangiopan-creatography.In order to generate a meaningful report based on these pre-operative imaging scans,it is also mandatory for the radiologist to be aware of the sur-geon’s perspective.We intend to provide a brief over-view of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans per-formed for LDLT related evaluation.

Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging

BACKGROUND Patients with pancreatic cystic neoplasms(PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging(MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound(US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US.AIM To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI.METHODS We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings.In this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol(abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.RESULTS In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients(1%) because of the appearance of suspicious features at imaging(with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients(14%). These comprised main pancreatic duct dilatation(n = 1), increased size of the main cyst(n = 14) and increased number of PNC(n = 13). In all of these patients, MRI confirmed US findings, without adding more information.The bi-annual MRI identified evolution of the lesions not identified by US in only11 patients with intraductal papillary mucinous neoplasms(5.5%), largely consisting of an increased number of very small PCN(P = 0.14). The overall mean cost of surveillance, based on a theoretical use of the European evidenced-based exclusive MRI surveillance in the same group of patients, would have been 1158.9± 798.6 € per patient, in contrast with a significantly lower cost of 366.4 ± 348.7 €(P < 0.0001) incurred by the US-restricted MRI surveillance used at our institution.CONCLUSION In patients with non-surgical PCN at the time of diagnosis, US surveillance could be a safe complementary approach to MRI, delaying and reducing the numbers of second level examinations and therefore reducing the costs.

Ductography and Galactomosynthesis in the 21st Century: Role of Imaging in Identifying Endoductal Breast Lesions and in Pre-Surgical Planning

Objective: To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. Methods: We retrospectively evaluated cytological outcomes, non-invasive/invasive breast imaging obtained between January 2016 and December 2019 in women with pathological nipple discharge (PND). We analysed sensitivity, specificity, positive predictive value and negative predictive value. We also evaluated the advantages of a pre-surgical radiological study using an endoductal contrast medium (with 3D-technique, in young women with dense breasts). Results: A total of 286 women with PND underwent cytological examination, mammography and/or breast ultrasound. When the cytological outcome was reported as “negative” (66.78%) in agreement with negative noninvasive imaging, patients were sent to follow up. Patients with cytological outcomes defined as “bloody with papillary clusters” (29.37%) “bloody not associated to cytological modifications” (2.44%), or “atypical/suspected” for malignant (1.39%) underwent an invasive procedure. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively: 92.63%, 100%, 100% and 96.46% for cytological examination;64.28%, 96.95%, 60% and 97.44% for mammography;41.11%, 97.44%, 88.09% and 78.27% for ultrasound;93.68%, 100%, 100% and 96.95% for invasive procedures. Post-surgical histological outcomes confirmed the diagnosis. Conclusion: In absence of a standard diagnostic algorithm, we recommend invasive procedures to identify intraductal breast lesions and for preoperative planning. Digital imaging and new technologies such as 3D-tomosynthesis lead to a renaissance of breast invasive imaging;they are confirmed to be an essential diagnostic modality for preoperative planning, to define localization and extension of multiple coexisting endoductal lesions.

Magnetic resonance imaging of the transplanted pediatric heart as a potential predictor of rejection

AIM To evaluate cardiac magnetic resonance imaging(CMR) as a non-invasive tool to detect acute cellular rejection(ACR) in children after heart transplant(HT).METHODS Thirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy(EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions(EFs), T2-weighted signal intensities, native T1 times, extracellular volumes(ECVs) and presence of late gadolinium enhancement(LGE) were compared between patients and controls and betweenpatients with International Society of Heart and Lung Transplantation(ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate(HR) and brain natriuretic peptide(BNP) were assessed as potential biomarkers.RESULTS Significant ACR(ISHLT grade ≥ 2R) was an infrequent event in our population(5/30, 17%). Ventricular volumes,EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR.CONCLUSION In this pilot study CMR did not reliably identify ACRrelated changes in pediatric HT patients.

Imaging investigation of pancreatic cystic lesions and proposal for therapeutic guidelines

AIM:To propose a diagnostic algorithm for preoperatively predicting the need for surgical intervention.METHODS:The study included 56 patients(27 men and 29 women) with a final diagnosis of cystic pancreatic lesions.The following materials were used:ultrasonic equipment with 3.5 and 7 MHz linear,convex and biopsical transducers.Multidetector computed tomography(MDCT) investigations were performed using a 16-slice scanner.Images were obtained following the oral administration of 200 mL water and 100 mL intravenous iopamidol(300 mg/mL) administered by pump injector at a rate of 3 mL/s(40 and 60 s post-injection,respectively) using 0.5 mm detectors,reconstructed at 1 mm(pancreatic phase) or 2 mm(portal venous phase) increments.The table feed was 10 mm per rotation.Images were acquired in the pancreatic and portal venous phases of contrast enhancement.The 'Chiba' needles 18,20,22,23 G and an automatic aspiration system were used in conjunction with the followingmethods of guiding the interventional procedures:(1) 'free-hand' biopsy and puncture method under ultrasound(US) or computed tomography(CT) control;(2) guiding method using biopsical transducer.RESULTS:All 56 patients in this study underwent at least two cuts imaging survey methods,such as US,CT or magnetic resonance imaging(MRI).The most common preoperative diagnostic examination was US scan-56 patients(100%).MDCT studies were conducted in 49(87.50%) and MRI in 13(23.21%).More than half of patients surveyed(37) underwent some type of interventional procedure:25-fine-needle aspiration and 29-fine needle aspiration biopsy(FNAB),as part of the examination.Thirty-four patients of all 56 patients underwent surgery because of histological evidence of malignancy after the FNAB for cystic lesions of the pancreas.Distal pancreatectomy with splenectomy was the most common operative approach in 13 patients,followed by Whipple resection in 11 and distal pancreatectomy without splenectomy in 7.Three patients were treated with total pancreatectomy due to the presence of a multifocal mucinous neoplasm.Comparing the diagnostic results of US examination with those of MDCT examination and histological verification true positive results were found in 31 patients,true negative in 11 patients,false positive in 5 and false negative in 9 patients.Accordingly we estimated the power of the diagnostic imaging methods for cystic lesions of the pancreas.A specificity of 68.75%,sensitivity of 79.48%,accuracy of 75.00%,positive predictive value of 86.11% and negative predictive value of 55% were obtained.The power increased after applying invasive procedures with immunohistochemical analysis of CEA and P-53(Fig.4).In 15 patients with cytological feature of malignant tumour cells,the tumour markers were positive.In our opinion the higher the percentage of reacting cells the higher the percent of malignancy.In patients with clear symptoms and/or clear imaging features of malignant or premalignant cystic neoplasm,the need for surgery was confirmed by histological verification in 34(60.71%) of cases.CONCLUSION:By using the proposed algorithm,cystic mucinous tumors of the pancreas were detected and proper operative interventions would have been rendered with fewer diagnostic examinations.

Rare Case of Adult Congenital Cystic Adenomatoid Malformation Diagnosed with CT Perfusion Imaging and Hystological Sample

We describe the case of a 44-year-old man with congenital cystic adenomatoid malformation. Both computed tomographic (CT) scan findings with perfusion protocol and histological biopsy led to diagnosis. CT scan showed multiple terminal bronchiolar-like uniform cysts smaller than 2 cm and CT perfusion allowed to make a differential diagnosis with an usual interstitial pneumonia. In order to make a definite diagnosis, an open lung biopsy confirmed the CT findings.

³¹P MR Spectroscopy with 3D Chemical-Shift Imaging Detects Changes in Levels of Phosphorus Metabolites Due to Saliva Secretion in Human Parotid Glands

.Objectives: To measure phosphorus metabolites in human parotid glands by 31P-MRS using three-dimensional chemical-shift imaging (3D-CSI), and ascertain whether this method can capture changes in adenosine triphosphate (ATP) and phosphocreatine (PCr) levels due to saliva secretion. Study Design: The parotid glands of 20 volunteers were assessed by 31P-MRS using 3D-CSI on 3T MRI. After obtaining a first (baseline) measurement, the participants took vitamin-C tablets and measurements were obtained twice more, in a continuous manner. The peak area ratios of PCr and β-ATP were evaluated. Results: A high proportion of PCr (0.26 ± 0.08) and ATP (α: 0.16 ± 0.06;β: 0.27 ± 0.06;γ: 0.21 ± 0.03) was noted at baseline. A significant decrease in β-ATP was observed between baseline (“pre”;0.27 ± 0.06) and the first scan after vitamin-C stimulation (“post-1”;0.19 ± 0.07, p < 0.05). There was a near-significant decrease in PCr between pre (0.26 ± 0.08) and post-1 (0.23 ± 0.06, p = 0.074). Conclusions: 31P-MRS with 3D-CSI can assess the major phosphorus metabolites in human parotid glands and capture changes in their levels due to saliva secretion. This technique is simple, non-invasive, and provides new information regarding saliva secretion.

The High Frequency (HF) Ultrasound as a Useful Imaging Technique for the Efficacy Assessment of Different Anti-Cellulite Treatments

The purpose of the research was to evaluate the role of high frequency ultrasound in monitoring and efficacy assessment of anti-cellulite treatments. A group of 66 women used 3 different types of anti-cellulite treatments;additionally a placebo group (n = 18) was created. The μ-Scan ultrasound device with a 35 MHz mechanical probe was used for the examinations. The following parameters were subjected to the ultrasound evaluation: epidermis thickness, dermis thickness, dermis echogenicity, the length and area of subcutaneous tissue bands projecting into the dermis (dermis-hypodermis junction), as well as the presence/absence of edema within the dermis. As a result of anti-cellulite treatment, the length and area of dermis-hypodermis junction significantly decreased, and dermis echogenicity significantly increased. Ultrasound imaging made it possible to evaluate the efficacy of the applied treatments. The high frequency ultrasound is a useful imaging technique for the application in aesthetic dermatology and cosmetology.

Perinephric myxoid pseudotumor of fat in a young patient with a horseshoe kidney complicated by an obstructing renal calculus

Dear Editor,Perinephric myxoid pseudotumor of fat(PMPF)is a recently described entity with only a few cases published in the literature.On imaging,the appearances overlap with other better-known fat-containing lesions such as angiomyolipoma and retroperitoneal liposarcoma.We present a novel case of PMPF in a young male patient with horseshoe kidney.We discuss the imaging characteristics on computed tomography(CT)and magnetic resonance imaging,differential diagnoses,as well as the histopathological features of this rare entity.Consent was obtained from the patient for treatment and publication.

Applications of time series analysis in epidemiology: Literature review and our experience during COVID-19 pandemic

Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways:Prediction and forecast.Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role.Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences.The time series analysis approach has the advantage of being easier to use(in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average).Still,it is limited in forecasting time,unlike the classical models such as Susceptible-Exposed-Infectious-Removed.Its applicability in forecasting comes from its better accuracy for short-term prediction.In its basic form,it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures(governments,companies,etc.).Instead,it estimates from the data directly.Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread;be it school closures,emerging variants,etc.It can be used in mortality or hospital risk estimation from new cases,seroprevalence studies,assessing properties of emerging variants,and estimating excess mortality and its relationship with a pandemic.

More to it than meets the eye: a case report of incomitant esotropia in a child caused by a giant basilar aneurysm

Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.